Profilaxia antiemética em cirurgia de abdome agudo: estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona

Víctor Contreras-Domínguez; Paulina Carbonell-Bellolio

doi:10.1590/S0034-70942008000100005

Scientific Article

Profilaxia antiemética em cirurgia de abdome agudo: estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona

Prophylactic antiemetic therapy for acute abdominal surgery: a comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone

Víctor Contreras-Domínguez; Paulina Carbonell-Bellolio

http://dx.doi.org/10.1590/S0034-70942008000100005 Braz J Anesthesiol, vol.58, n1, p.35-44, 2008

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Resumo

JUSTIFICATIVA E OBJETIVOS: A incidência de náuseas e vômitos pós-operatórios (NVPO) gira em torno de 30%. A profilaxia de NVPO foi objeto de múltiplos estudos, tanto para tentar diminuir esse problema como para comparar o índice custo-benefício do tratamento utilizado. Esse estudo comparou a eficácia de cinco fármacos antieméticos em apendicectomia. MÉTODO: Estudo clínico prospectivo controlado, duplamente encoberto de 150 pacientes ASA I e II com IMC < 30, submetidos a apendicectomia. Os pacientes foram divididos em seis grupos: Grupo 1 (n = 25): 5 mL solução fisiológica a 0,9%; Grupo 2 (n = 25): droperidol 0,625 mg; Grupo 3 (n = 25): metoclopramida 20 mg; Grupo 4 (n = 25): tropisetron 5 mg; Grupo 5 (n = 25): granisetron 1 mg; Grupo 6 (n = 25): dexametasona 4 mg. A monitoração foi realizada com ECG, PANI, SpO2, P ET CO2, analisador de gases anestésicos e estimulador de nervo periférico. Foi avaliada a presença de NVPO, complicações e o grau de satisfação nas primeiras 48 horas. RESULTADOS: O droperidol apresentou incidência 4% de NVPO, os grupos de granisetron, tropisetron e metoclopramida apresentaram 12% de NVPO (p < 0,05). O grupo de dexametasona apresentou 24% e o controle 28% de NVPO. CONCLUSÕES: Na profilaxia de NVPO em apendicectomia de urgência o uso de baixas doses de droperidol foi mais efetivo que o dos outros fármacos.

Palavras-chave

ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, CIRURGIA, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: It is calculated that the incidence of postoperative nausea and vomiting (PONV) is approximately 30%. The prophylaxis of PONV has been the subject of several studies, both to decrease this problem and to compare the cost-benefit ration of the treatment used. The objective of this study was to compare the efficacy of 5 antiemetic drugs with a control group in emergency appendectomy. METHODS: A controlled, double-blind, prospective study with 150 patients, ASA I and II, BMI < 30, undergoing appendectomy, was undertaken. Patients were divided in six groups: Group 1 (n = 25): 5 mL of normal saline; Group 2 (n = 25): 0.625 mg of droperidol; Group 3 (n = 25): 20 mg of metoclopramide; Group 4 (n = 25): 5 mg of tropisetron; Group 5 (n = 25): 1 mg of granisetron; Group 6 (n = 25): 4 mg of dexamethasone. Monitoring included ECG, non-invasive blood pressure, O2 saturation, P ET CO2, anesthetic gas analyzer and peripheral nerve stimulator. The presence of PONV, complications and the degree of satisfaction in the first 48 hours were evaluated. RESULTS: The incidence of PONV in the droperidol group was 4% while in the granisetron, tropisetron and metoclopramide groups it was 12% (p < 0.05). The dexamethasone group had a 24% incidence and the control group 28%. CONCLUSIONS: Low doses of droperidol were more effective in the prophylaxis of PONV in emergency appendectomy than the other drugs.

Keywords

ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, COMPLICATIONS, COMPLICATIONS, SURGERY, SURGERY

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Profilaxia antiemética em cirurgia de abdome agudo: estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona

Prophylactic antiemetic therapy for acute abdominal surgery: a comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone

Víctor Contreras-Domínguez; Paulina Carbonell-Bellolio

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