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Effectiveness of alimemazine in controlling retching after Nissen fundoplication
Brice Antao1, Kuan Ooi, Nye Ade-Ajayi
1Department of Paediatric Surgery, Great Ormond Street Hospital, WC1N 3JH London, UK.
Insights
Alimemazine effectively reduces retching in children post-Nissen fundoplication. This study found a significant decrease in retching episodes with alimemazine compared to placebo, with no reported adverse effects.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pharmacology
Background:
- Retching is a common, distressing symptom following Nissen fundoplication in children.
- Alimemazine, a phenothiazine derivative and histamine H1 antagonist, is anecdotally reported to alleviate these symptoms.
Purpose of the Study:
- To evaluate the efficacy and safety of alimemazine in managing post-Nissen fundoplication retching in pediatric patients.
- To compare alimemazine treatment against a placebo in a randomized, double-blind, crossover study.
Main Methods:
- Prospective, double-blind, randomized, crossover, placebo-controlled study involving 15 neurologically impaired children.
- Patients received 1 week of alimemazine (0.25 mg/kg TID) and 1 week of placebo, with a crossover period.
- Retching episodes were recorded in diaries for 1 week before, during, and after each treatment phase.
Main Results:
- A significant reduction in weekly retching episodes was observed with alimemazine (10.42 ± 9.48) compared to placebo (47.67 ± 27.79) (P < .0001).
- Twelve children completed the study, with no adverse effects reported.
- The study included children with a median age of 36 months and a median duration of retching of 4.5 months.
Conclusions:
- Low-dose alimemazine is a safe and effective treatment for retching in children after Nissen fundoplication.
- Alimemazine offers a promising therapeutic option for managing this common post-surgical complication.
Background:
Retching, an early component of the emetic reflex, is a common and distressing symptom in children after Nissen fundoplication. Alimemazine (trimeprazine, Vallergan; Castlemead, Herts, UK) is a phenothiazine derivative histamine(1) antagonist, which anecdotally relieves the retching symptoms.
Material And Methods:
A prospective, double-blind, randomized, crossover, placebo-controlled study of 15 neurologically impaired children with retching after Nissen fundoplication over a period of 1 year (December 2002-December 2003). Patients were randomly allocated to receive 1 week each of alimemazine and placebo with crossover. A diary was maintained of retching episodes 1 week before, during, and 1 week after the trial. Dosage of alimemazine used was 0.25 mg/kg 3 times a day (maximum, 2.5 mg per dose). Statistical analysis was done using a paired Student's t test, where P value of less than .05 was considered significant. Results are presented as mean +/- SD.
Results:
Twelve parents completed the diaries (9 open, 3 laparoscopic Nissen fundoplication). Median age of the child was 36 months (8-180 months), median duration of retching was 4.5 months (1-52 months), and mean number of retching episodes per week was 60 +/- 29.40. Mean number of retching episodes with alimemazine was 10.42 +/- 9.48 vs 47.67 +/- 27.79 with a placebo (P < .0001). No adverse effects were reported in those cases that completed the study.
Conclusion:
At low dose, alimemazine (Vallergan) is a safe and effective drug in the management of retching after Nissen fundoplication.
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