Tang J, Watcha M F, White P F
Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas 75235-9068, USA.
Anesth Analg. 1996 Aug;83(2):304-13. doi: 10.1097/00000539-199608000-00018.
Ondansetron and droperidol are both effective prophylactic antiemetics for gynecologic outpatient procedures. However, increased drowsiness, delayed discharge, and postdischarge restlessness may occur with droperidol, and ondansetron is costly. In this prospective, randomized, double-blind, placebo-controlled study involving 161 women, we compared the efficacy, safety, and cost-effectiveness of ondansetron (4 mg intravenously [i.v.] with droperidol (0.65 mg or 1.25 mg i.v.) in the prevention of postoperative nausea and vomiting (PONV) after outpatient gynecologic surgery. The incidence of PONV, times to achieving preset recovery criteria, and patient-evaluated visual analog scales for sedation, anxiety, pain, and nausea were recorded, along with postdischarge emetic episodes, medications, quality of sleep, and time to resumption of food intake, normal activity, and return to work. A decision analysis tree was used to divide each data set into nine mutually exclusive subgroups, and costs and probabilities were assigned to each subgroup. The cost-effectiveness ratio was determined by summing these weighted costs and dividing by the number of patients free from both PONV and side effects of antiemetic therapy. The incidence of PONV in the hospital and after discharge, the need for rescue antiemetic therapy, and recovery and discharge times were similar for the ondansetron and both droperidol groups but differed significantly from those for the placebo group. The cost-effectiveness ratios for both droperidol 0.65 mg and 1.25 mg groups were significantly lower than those for the ondansetron and placebo groups. We conclude that droperidol 0.625 mg i.v. provides antiemetic prophylaxis comparable to that of ondansetron 4 mg i.v. without increasing side effects or delaying discharge and is most cost-effective.
昂丹司琼和氟哌利多都是妇科门诊手术有效的预防性止吐药。然而，使用氟哌利多可能会出现嗜睡增加、出院延迟和出院后烦躁不安的情况，且昂丹司琼成本较高。在这项涉及161名女性的前瞻性、随机、双盲、安慰剂对照研究中，我们比较了静脉注射4毫克昂丹司琼与静脉注射0.65毫克或1.25毫克氟哌利多在预防妇科门诊手术后恶心和呕吐（PONV）方面的疗效、安全性和成本效益。记录了PONV的发生率、达到预设恢复标准的时间以及患者评估的镇静、焦虑、疼痛和恶心视觉模拟量表，同时记录了出院后呕吐发作情况、用药情况、睡眠质量以及恢复进食、正常活动和重返工作岗位的时间。使用决策分析树将每个数据集分为9个相互排斥的亚组，并为每个亚组分配成本和概率。成本效益比通过将这些加权成本相加并除以无PONV和止吐治疗副作用的患者数量来确定。昂丹司琼组和两个氟哌利多组在医院和出院后的PONV发生率、抢救性止吐治疗需求以及恢复和出院时间相似，但与安慰剂组有显著差异。0.65毫克和1.25毫克氟哌利多组的成本效益比均显著低于昂丹司琼组和安慰剂组。我们得出结论，静脉注射0.625毫克氟哌利多提供的止吐预防效果与静脉注射4毫克昂丹司琼相当，且不会增加副作用或延迟出院，是最具成本效益的。
