Acute Pain (2009) 11, 143144

LETTER TO THE EDITOR

Continuing use of droperidol in controlled analgesia with morphine patient-

KEYWORDS

Droperidol; Patient-controlled analgesia; Nausea; Vomiting Intravenous patient-controlled analgesia (PCA) with morphine is commonly used after major surgery. Nausea and vomiting are frequent adverse effects, but the incidence can be reduced by using prophylactic antiemetics. Droperidol, a butyrophenone, has been shown to be effective across a dose range of 0.0170.17 mg/mg of morphine [1] and has been used safely for many years with morphine PCA. Unfortunately it received a US Food and Drug Administration alert in 2001 indicating that cases of QT prolongation and/or torsades de pointes had been reported [2] and although this has been challenged [3] droperidol has subsequently been increasingly difcult to source. We have used droperidol in morphine PCA at Barnsley Hospital almost continuously for 10 years, initially in a dose of 0.1 mg/mg of morphine (no = 2409) and then in a dose of 0.042 mg/mg of morphine (no = 2124). Due to supply problems in 2003, a smaller group of patients (no = 192) received morphine only PCAs. The higher dose was supplied in pre-mixed syringes (morphine 60 mg/droperidol 6 mg) and therefore the 24 h dose of droperidol ranged from 0 to 18.2 mg. The lower dose (2.5 mg) is added to the rst syringe only giving a 24 h dose range of 02.5 mg. Patients for review underwent a variety of major surgical procedures including bowel resection, joint replacement and total abdominal hysterectomy with different anaesthetic techniques employed but excluding epidural infusions or intrathecal opi-

Figure 1 Incidence of nausea and/or vomiting following different doses of droperidol compared to no droperidol in PCA morphine.

ates. Patients were reviewed at 24 h by the Acute Pain Team and asked whether they had experienced any nausea and/or vomiting since their surgery. The results (Fig. 1) show that the incidence of nausea and vomiting is signicantly reduced by the addition of droperidol to morphine PCA. A dose of 0.1 mg/mg of morphine has been recommended as optimal [4] but our data suggest that a lower dose is more effective. Anecdotally we have found less sedation and dizziness using the lower dose and to our knowledge there have been no dysrhythmias associated with either dose of droperidol. Our pharmacy sources droperidol from Doncaster Pharmaceuticals; a box of 10 ampoules (2.5 mg/ml) costs 43.95 ex VAT (unlicensed product). It is manufactured in France and marketed by Prostrakan which does have UK marketing authorisation despite it being an unlicensed product. It is relatively more expensive now and is certainly more difcult to source but there are still few, if any, alternative cost-effective antiemetics for adding to morphine PCA.

References
[1] Tramer MR, Walder B. Efcacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia

1366-0071/$ see front matter 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.acpain.2009.09.002

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therapy: a quantitative systematic review. Anesthesia and Analgesia 1999;88(6):135461. [2] McCormick CG. FDA alert: current FDA report on droperidol status and basis for Black Box warning. ASA Newsletter 2002;66:1920. [3] Gan TJ, White PF, Scuderi PE, Watcha MF, Kovac A. FDA Black Box warning regarding use of droperidol for postoperative nausea and vomiting: is it justied? Anesthesiology 2002;97:287. [4] Lamond CT, Robinson DL, Boyd JD, Cashman JN. Addition of droperidol to morphine administered by the patient controlled analgesia method: what is the optimal dose? European Journal of Anaesthesiology 1998;15: 3049.

Letter to the Editor C.M. Ball ST3 Anaesthetics, Shefeld Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Shefeld, S10 2JF, UK P. Claydon Barnsley Hospital NHS Foundation Trust, Barnsley, UK Corresponding author. E-mail address: claremball@yahoo.co.uk (C.M. Ball) 3 September 2009 Available online 14 October 2009

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