Ho et al. Anesth Analg 2001; 92: 745-8

Reviewed by: R. Prasad, MD

Summary:

• Epidural morphine: 30-65% incidence N/V
• Dexamethasone effective antiemetic: 5 mg dose recommended
• Drop 1.25 had 14% incidence of restlessness

• Fairly high incidence of restlessness
• due to lack of other sedatives, residual anesthetic, etc?
• what if used 0.625mg?
• PONV in placebo group was 56%; their power analysis assumed 60%. However, their treatment groups reduced N/V to ~20% (vs. 36% in power analysis). So, study probably still adequately powered.

• 245 ASA I-II, 35-55yo women for abdominal hysterectomy under epidural anesthesia
• Power analysis: assuming 60% incidence of N/V in placebo group, needed 40 pts/group to show 40% reduction in N/V (to 36%) in treatment group, with alpha=0.05, beta=-0.2
• Randomized, double-blind, placebo-controlled
• 5 groups (45 each): placebo, droperidol 1.25mg, dexameth 2.5, 5, or 10mg; med given after closure.
• Epidural morphine 3mg given 1 minute later.
• 24hr observation.

• 11 pts withdrawn (failed cath, incomplete data); still >40 each group
• Similar demographics, surgical info, analgesic requirements
• Incidence of N/V: placebo and Dex 2.5 groups similar; other 3 groups similar (only significant differences shown below):

• No reported wound infections, delayed wound healing
• Significantly more pts in Drop group (6,14%)  reported restlessness

• Drop restlessness relieved by IM diphenhydramine
• Dex 5mg as effective as 10, with no apparent complications