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Cisapride does not prevent postoperative vomiting in children
Scott D Cook-Sather1, Kathleen A Harris, Mark S Schreiner
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104, USA. sather@email.chop.edu
Insights
Cisapride did not prevent postoperative vomiting in children after surgery. The drug may even increase the severity of vomiting, suggesting other factors are more influential.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Pharmacology
Background:
- Opioid administration during general anesthesia can cause gastrointestinal paresis.
- Postoperative vomiting (POV) is a common complication in children following surgery.
- Cisapride, a prokinetic agent, has been investigated for its potential to mitigate opioid-induced gastrointestinal effects.
Purpose of the Study:
- To determine if cisapride reduces the incidence of postoperative vomiting in children undergoing inguinal surgery.
- To evaluate the efficacy of cisapride in preventing vomiting after general anesthesia supplemented with morphine.
Main Methods:
- Prospective, randomized, double-blinded, placebo-controlled trial.
- 96 children undergoing inguinal surgery were divided into three groups: cisapride before surgery and placebo after (C1), cisapride before and after surgery (C2), and placebo for both (P).
- Incidence and severity of postoperative vomiting were assessed in-hospital and at home.
Main Results:
- No significant difference in the incidence of postoperative vomiting was observed between the cisapride groups (C1+C2) and the placebo group (P) in-hospital (32% vs 20%) or at home (53% vs 46%).
- A trend towards more severe postoperative vomiting (≥3 episodes) was noted in children who received cisapride compared to placebo, both in-hospital (6% vs 0%) and at home (22% vs 8%).
- Pain scores, parent satisfaction, and need for rescue analgesics were similar across all groups.
Conclusions:
- Cisapride does not effectively prevent postoperative vomiting in pediatric patients undergoing surgery with general anesthesia and opioid analgesia.
- The use of cisapride may be associated with an increased severity of postoperative vomiting in this population.
- Factors beyond gastrointestinal motility likely play a more significant role in the development of postoperative vomiting.
Unlabelled:
The peripherally acting prokinetic drug cisapride can overcome opioid-induced gastrointestinal paresis and may thereby eliminate a stimulus for postoperative vomiting. We conducted a prospective, randomized, double-blinded, controlled trial of 96 children undergoing inguinal surgery to determine whether cisapride would reduce the incidence of postoperative vomiting after general anesthesia supplemented with morphine. Group C1 patients (n = 38) received cisapride 0.3 mg/kg orally 1 h before surgery and placebo 6 h later, Group C2 (n = 28) received cisapride both before and after surgery, and Group P (n = 30) received placebo. Mean age (5.0 +/- 2.7 yr) and weight (21.0 +/- 8.6 kg), median pain scores and parent satisfaction scores, and incidence of rescue analgesic administration were similar across groups. Contrary to our hypothesis, incidences of postoperative vomiting in the hospital (32% vs 20%, P = 0.33) and at home (53% vs 46%, P = 0.33) did not vary by treatment group (with [C1 and C2] and without [P] cisapride, respectively). There was a trend toward more severe postoperative vomiting (three or more episodes) in children who received cisapride versus those who did not, both in hospital (6% vs 0%, P = 0.3) and at home (22% vs 8%) (P = 0.13). We conclude that cisapride does not prevent postoperative vomiting in this patient population and speculate that factors other than reduced gastrointestinal motility associated with general anesthesia and opioids are more important determinants of postoperative vomiting.
Implications:
Cisapride does not prevent postoperative vomiting in children and may increase its severity.