Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjan.2012.07.011
Brazilian Journal of Anesthesiology
Scientific Article

A associação de haloperidol, dexametasona e ondansetrona reduz a intensidade de náusea, dor e consumo de morfina após gastrectomia vertical laparoscópica

Combination of haloperidol, dexamethasone, and ondansetron reduces nausea and pain intensity and morphine consumption after laparoscopic sleeve gastrectomy

Márcio Luiz Benevides; Sérgio de Souza Oliveira; José Eduardo Aguilar-Nascimento

http://dx.doi.org/10.1016/j.bjan.2012.07.011 Braz J Anesthesiol, vol.63, n5, p.404-409, 2013
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Resumo

JUSTIFICATIVA E OBJETIVOS: Náusea e vômito pós-operatório (NVPO) ocorrem frequentemente após cirurgia bariátrica laparoscópica. A associação de haloperidol, dexametasona e ondansetrona pode reduzir esses eventos indesejáveis. O objetivo deste estudo foi avaliar a intensidade de náusea e dor, o número de episódios de vômito e o consumo de morfina no pós-operatório (PO) de pacientes obesos submetidos à gastrectomia vertical laparoscópica (GVL). MÉTODO: Estudo clínico, aleatorizado, controlado e duplamente encoberto feito em 90 pacientes com índice de massa corporal > 35 kg.cm-2. Os pacientes foram distribuídos em três grupos de 30 para receberem no Grupo O: ondansetron 8 mg; no Grupo DO: ondansetron 8 mg e dexametasona 8 mg e no Grupo HDO: ondansetron 8 mg, dexametasona 8 mg e haloperidol 2 mg. Foram avaliados a intensidade de náusea e dor, por meio de escala numérica verbal, o número cumulativo de episódios de vômito e o consumo de morfina no período de 0-2, 2-12, 12-24 e 24-36 horas de PO. RESULTADOS: A intensidade de náusea foi menor no Grupo HDO comparado com o Grupo O (p = 0,001), a intensidade da dor foi menor no Grupo HDO comparado com o Grupo O (p = 0,046) e o consumo de morfina no Grupo HDO foi menor do que no Grupo O (p = 0,037). Não houve diferença do número de episódios de vômito entre os grupos (p = 0,052). CONCLUSÃO: A associação de haloperidol, dexametasona e ondansetron promoveu redução da intensidade de náusea, da dor e do consumo de morfina no PO de pacientes obesos submetidos à GVL.

Palavras-chave

DROGAS, Antiemético, Haloperidol, Ondansetron, Dexametasona, CIRURGIA, Bariátrica, COMPLICAÇÕES, Náusea, Vômito

Abstract

BACKGROUND AND OBJECTIVE: Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). METHOD: A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index > 35 kg.cm-2. Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2 mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. RESULTS: Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). CONCLUSION: The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

Keywords

Antiemetics, Haloperidol, Dexamethasone, Ondansetron, Bariatric Surgery, Postoperative Nausea and Vomiting

References

Moussa AA, Oregan PJ. Prevetion of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery: Granisetron alone vs granisetron combined with dexamethasone/droperidol. M.E.J. Anesth. 2007;19(2):367-368.

Mendes MN, Monteiro RS, Cruz Martins FAN. Profilaxia de náuseas e vômitos pós-operatórios em obesos mórbidos submetidos a gastroplastias por laparoscopias: Estudo comparativo entre três métodos. Rev Bras Anestesiol. 2009;59(5):570-576.

Perkins P, Dorman S. Haloperidol for the treatment of nausea and vomiting in palliative care patient. Cochrane Database of Systematic Reviews. 2009.

Chu CC, Shieh JP, Tzeng JI. The prophylactic effect of haloperidol plus dexamethasone on postoperative nausea and vomiting in patients undergoing laparoscopically assisted vaginal hysterectomy. Anesth Analg. 2008;106:1402-1406.

Wang TF, Liu YH, Chu CC. Low-dose haloperidol prevents post-operative nausea and vomiting after ambulatory laparoscopic surgery. Acta Anaesthesiol Scand. 2008;52:280-284.

Karanicolas PJ, Smith SE, Kanbur B. The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis. Ann Surg. 2008;248:751-762.

Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000;90:186-194.

Laer S, Scholz J, Ritterbach C. Association between increased 5-HIAA plasma concentrations and postoperative nausea and vomiting in patients undergoing general anaesthesia for surgery. Eur J Anaesth. 2001;18(12):833-835.

Tramer MR, Reynolds DJ, Moore RA. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a qualitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;87:1277-1289.

O'Brein PE. Bariatric surgery: mechanisms, indications, and outcomes. J Gastroenterol Hepatol. 2010;25:1358-1365.

Chu CC, Shieh JP, Tzeng JI. The prophylactic effect of haloperidol plus dexamethasone on postoperative nausea and vomiting in patients undergoing laparoscopically assisted vaginal hysterectomy. Anesth Analg. 2008;106:1402-1406.

Rosow CE, Haspel KL, Smith SE. Haloperidol versus ondansetron for prophylaxis of postoperative nausea and vomiting. Anesth Analg. 2008;106:1407-1409.

White PF, O'Hara JF, Roberson CR. The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients. Anesth Analg. 2008;107:452-458.

Voigt M, Fröhlich CW, Waschke KF. Prophylaxis of postoperative nausea and vomiting in elective breast surgery. Journal of Clinical Anesthesia. 2011;23:461-468.

Carlise JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006.

Le TP, Gan TJ. Update on the management of postoperative nausea and vomiting and postdischarge nausea and vomiting in ambulatory surgery. Anesthesiology Clin. 2010;28:225-249.

Apfel CC, Laara E, Koivuranta M. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693-700.

Sánchez-Rodríguez PE, Fuentes-Orozco C, González-Ojeda A. Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial. World J Surg. 2010;34:895-900.

Zhou H, Xu H, Zhang J. Combination of dexamethasone and tropisetron before thyroidectomy to alleviate postoperative nausea, vomiting, and pain: randomized controlled trial. World J Surg. 2012;7:1217-1224.

Feroci F, Rettori M, Borrelli A. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck. 2011;33(6):840-846.

Edwards J, Meseguer F, Faura C. Single dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev. 2010.

De Oliveira Jr GS, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg. 2012;114(2):424-433.

De Oliveira Jr GS, Almeida MD, Benzon HT. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115:575-588.

Fujii Y, Itakura M. Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2010;24:692-696.

Jokela RM, Ahonen JV, Tallgren M. The effective analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesth Analg. 2009;109:607-615.

Murphy GS, Szokol JW, Greenberg SB. Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy effect on in-hospital and postdischarge recovery outcomes. Anesthesiology. 2011;114:882-890.

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