Antidopaminergics

 

Amisulpride

  • Dopamine D2, D3 receptors antagonist

  • 5 mg IV for treatment of PONV

 

Droperidol

 

  • 0.625 mg IV at the end of surgery 

  • Efficacy similar to ondansetron for PONV prophylaxis 

  • NNT = 5 for both nausea & vomiting prevention 

  • QTc prolongation issues: 

  • FDA "black box" restriction 2001; however, doses used for PONV prophylaxis unlikely to ↑ QTc.  Studies show equal QTc effects to Ondansetron 

 

Haloperidol 

 

  • 0.5-<2mg IV or IM at the end of surgery 

  • With these low doses, sedation does not occur & cardiac arrhythmias are unlikely 

  • QTc prolongation is possible with Haldol, but studies have not shown higher risk than Ondansetron 

  • Extrapyramidal side effects are rare with one study suggesting 1/806 patients or 0.1%

 

Perphenazine 

 

  • 5 mg IV

  • No increase in sedation or drowsiness

 

Metoclopramide

  • Conflicting evidence due to prior meta-analysis including fabricated evidence

  • 10 mg IV for PONV prevention 

  • NNT 8-10

  • Dyskinesia or extrapyramidal symptoms reported at 0.4% (10 mg) and 0.8% (25-50 mg)

  • Consider if other dopamine antagonists not available

 

Adapted from Anesth Analg. August 2020 - Volume 131 - Issue 2 - p 411-448