Combination of droperidol and ondansetron reduces PONV after pediatric strabismus surgery more than single drug therapy

Background: Pediatric strabismus surgery is associated with a very high incidence of postoperative nausea and vomiting [(PONV) 44-88%]. Droperidol (10-75 mug kg-') and ondansetron (50-150 mug kg(-1)) have shown variable success in reducing the incidence and severity of PONV. Combination of these two drugs has shown promising results. This randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy and safety of the combination of these two drugs in reducing the incidence and severity of PONV in pediatric strabismus surgery. Methods: After institutional approval and parental informed consent, 240 children of ASA physical status I and II of either sex, aged 1-15 years were included in this study None of the children received any premedication and a standardized anesthesia technique was used for all the children. They were prospectively randomized to one of the four treatment groups. Group PP received normal saline placebo intravenously after induction and at the end of the procedure. Group Dr received droperidol 25 mug kg-' after induction and normal saline at the end. Group Or received ondansetron 150 mug kg(-1) after induction and saline at the end. Group DP received droperidol 15 mug kg-' after induction and ondansetron 100 mug kg(-1) at the end. Results: Combination prophylaxis resulted in a lower incidence of PONV (13%) as compared to placebo (62.5%, P <0.001), ondansetron (37%, P <0.001), or droycn'dol (32%, P <0.01). Conclusion: Droperidol 15 mug kg(-1) in combination with ondansetron 100 mug kg-', administered at the induction and end of the operative procedure respectively, is more effective than either drug given individually in reducing the incidence of PONV after strabismus surgery.