Background: To give prophylactics or timely
treatment for post-operative nausea and vomiting (PONV) is the question. We
compared the intensity and number of disturbing post-operative symptoms (i.e.
pain, PONV, headache, fatigue, etc.) after prophylactic antiemetic treatment in
a group of patients with >30% risk for post-operative vomiting.
Methods: Four hundred and ninety-five patients, from three hospitals,
planned for gynaecological surgery were randomized double blind. They were
given granisetron 3 mg, droperidol 1.25 mg or no prophylactic
antiemetic. Post-operative symptoms were followed for 24 h using a
questionnaire. Symptoms were analyzed both according to their intensity and in
a dichotomous fashion.
Results: The intensity of different symptoms differed depending on
whether droperidol, granisetron or no antiemetic had been given (P = 0.005) but the overall incidence of
moderate to very severe symptoms was similar in all groups. No group fared
better in general. The total number of
symptoms was higher in the groups given prophylactic treatment (P < 0.05). The relative risk reduction for
PONV with granisetron or droperidol prophylaxis was 27%[95% confidence interval
(CI) 8–43] and 22% (2–38), respectively. The NNT (number needed to treat) for
granisetron (0–24 h) was 7 and for droperidol 8. The NNH (number needed to
harm) (0–24 h) for headache and visual disturbances was 6 and 13 (NS) for
granisteron and, 50 (NS) and 6 for droperidol.
Conclusion: The intensity of symptoms or the total number of disturbing
symptoms did not decrease after prophylactic antiemetic treatment in a group of
patients, but the profile of disturbing symptoms changed. The relevance of
post-operative symptoms in terms of patients' well-being needs to be addressed.