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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

Anesthesia and Analgesia
|January 5, 2002
PubMed
Summary

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.

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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).

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  • 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.