Department of Anesthesiology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Eur J Anaesthesiol. 2010 Dec;27(12):1052-7. doi: 10.1097/EJA.0b013e32833f53b8.
the objective of this study was to assess whether antiemetic drugs metoclopramide and diphenhydramine, administered together as opposed to alone, can have better efficacy in preventing postoperative nausea and vomiting when added to patient-controlled morphine analgesia.
during the period July 2007 to August 2008, 200 women scheduled for abdominal total hysterectomy were randomised to one of four postoperative, patient-controlled analgesia regimens: group 1, morphine 1 mg ml; group 2, morphine 1 mg ml with metoclopramide 0.5 mg ml; group 3, morphine 1 mg ml with diphenhydramine 0.6 mg ml; and group 4, morphine 1 mg ml with metoclopramide 0.5 mg ml and diphenhydramine 0.6 mg ml. Dexamethasone 4 mg was administered to all patients in all groups after anaesthesia induction as a prophylactic antiemetic medication, and prochlorperazine 5 mg was administered by intramuscular injection as necessary as a salvage/rescue therapy. Nausea, vomiting, pruritus, level of sedation, pain and morphine consumption were compared between the four groups.
the incidence of nausea was significantly (P < 0.05) lower in group 4 compared to the other groups. In addition, there was a significant (P = 0.006) difference in the incidence of vomiting between groups 1 and 4. Repeated measurement analysis showed that numeric rating scale scores for group 4 were significantly (P < 0.001) lower than those for the other groups.
results of this study showed that a combination of metoclopramide with diphenhydramine in patients treated with dexamethasone at anaesthesia induction decreased postoperative nausea and vomiting compared to metoclopramide or diphenhydramine in these patients, when added to patient-controlled anaesthesia with morphine.
本研究旨在评估止吐药甲氧氯普胺和苯海拉明联合应用（与单独应用相比）是否能在联合地佐辛自控镇痛时增强预防术后恶心呕吐的效果。
2007 年 7 月至 2008 年 8 月期间，选择 200 例行全腹部子宫切除术的女性患者，随机分为 4 组接受术后患者自控镇痛：第 1 组给予吗啡 1 mg/ml；第 2 组给予吗啡 1 mg/ml 加甲氧氯普胺 0.5 mg/ml；第 3 组给予吗啡 1 mg/ml 加苯海拉明 0.6 mg/ml；第 4 组给予吗啡 1 mg/ml 加甲氧氯普胺 0.5 mg/ml 和苯海拉明 0.6 mg/ml。所有患者均在麻醉诱导后给予地塞米松 4 mg 作为预防止吐药物，必要时给予甲氧氯普胺 5 mg 肌内注射作为补救/解救治疗。比较四组患者的恶心、呕吐、瘙痒、镇静程度、疼痛和吗啡消耗量。
第 4 组恶心的发生率明显（P < 0.05）低于其他组。此外，第 1 组和第 4 组之间呕吐的发生率存在显著差异（P = 0.006）。重复测量分析显示，第 4 组的数字评分量表评分明显（P < 0.001）低于其他组。
本研究结果表明，在接受麻醉诱导时给予地塞米松的患者中，与单独使用甲氧氯普胺或苯海拉明相比，将甲氧氯普胺与苯海拉明联合使用可减少术后恶心呕吐，同时联合地佐辛自控镇痛时使用吗啡。
