Eberhart L H, Seeling W, Ulrich B, Morin A M, Georgieff M
Department of Anaesthesiology, University of Ulm, Germany.
Can J Anaesth. 2000 Aug;47(8):780-5. doi: 10.1007/BF03019481.
Dimenhydrinate and metoclopramide are inexpensive antiemetic drugs. Metoclopramide, especially, has been studied extensively in the past, but there are no studies on the combination of both drugs for prevention of postoperative nausea and vomiting (PONV).
One hundred and sixty male inpatients undergoing endonasal surgery were randomized to receive one of four antiemetic regimens in a double-blind manner: placebo, 1 mg x kg(-1) dimenhydrinate, 0.3 mg x kg(-1) metoclopramide, or the combination of both drugs was administered after induction of anesthesia. Patients received a second dose of these drugs six hours after the first administration to mitigate their short half-life. Standardized general anesthesia included benzodiazepine premedication, propofol, desflurane in N2O/O2 vecuronium, and a continuous infusion of remifentanil. Postoperative analgesia and antiemetic rescue medication were standardized. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded for 24 hr. The incidences of PONV were analyzed with Fisher's Exact test and the severity of PONV (rated by a standardized scoring algorithm) with the Jonckheere-Terpestra-test.
The incidence of patients free from PONV was 62.5% in the placebo-group and increased to 72.5% in the metoclopramide-group (P = 0.54), 75.0% in the dimenhydrinate-group (P = 0.34), and 85.0% in the combination- group (P = 0.025). In the latter group, the severity of PONV was reduced compared with placebo treatment (P = 0.017; Jonckheere-Terpestra-test).
Dimenhydrinate and metoclopramide were ineffective in reducing the incidence and the severity of PONV. Their combination reduced the incidence of PONV compared with placebo.
茶苯海明和甲氧氯普胺是价格低廉的止吐药物。尤其是甲氧氯普胺，过去已被广泛研究，但尚无关于这两种药物联合使用预防术后恶心和呕吐（PONV）的研究。
160例接受鼻内手术的男性住院患者被随机双盲接受四种止吐方案之一：安慰剂、1mg·kg⁻¹茶苯海明、0.3mg·kg⁻¹甲氧氯普胺，或在麻醉诱导后给予两种药物的组合。患者在首次给药6小时后接受第二剂这些药物，以弥补其半衰期短的问题。标准化全身麻醉包括苯二氮䓬类药物术前用药、丙泊酚、N₂O/O₂中的地氟醚、维库溴铵以及瑞芬太尼持续输注。术后镇痛和止吐急救药物均标准化。记录24小时内的呕吐、干呕、恶心发作情况以及额外使用止吐药的需求。采用Fisher精确检验分析PONV的发生率，采用Jonckheere-Terpestra检验分析PONV的严重程度（通过标准化评分算法评定）。
安慰剂组无PONV患者的发生率为62.5%，甲氧氯普胺组增至72.5%（P = 0.54），茶苯海明组为75.0%（P = 0.34），联合用药组为85.0%（P = 0.025）。与安慰剂治疗相比，联合用药组PONV的严重程度降低（P = 0.017；Jonckheere-Terpestra检验）。
茶苯海明和甲氧氯普胺在降低PONV的发生率和严重程度方面无效。与安慰剂相比，它们的联合使用降低了PONV的发生率。
