Perioperative Medicine  |   June 2020
Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesiology, Perioperative and Pain Medicine (J.B.H., C.P., B.C., M.H., S.D.), Department of Population Health Science and Policy (H.-M.L.), Division of Gynecology, Department of Obstetrics, Gynecology and Reproductive Science (L.R., R.L.B.G., V.P., C.A.-W.), Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Blavatnik Family Women’s Health Research Institute (S.V.B.), and Division of Plastic and Reconstructive Surgery, Department of Surgery (P.J.T.), Icahn School of Medicine at Mount Sinai, New York, New York; Suzanne Fenske, M.D., P.C., Brookville, New York (S.S.F.); and Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts (S.B.P.).
  • Submitted for publication October 11, 2019. Accepted for publication March 2, 2020. Published online first on March 27, 2020. Corrected on June 5, 2020.
    Submitted for publication October 11, 2019. Accepted for publication March 2, 2020. Published online first on March 27, 2020. Corrected on June 5, 2020.×
  • Address correspondence to Dr. Hyman: Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, One Gustave L. Levy Place, Box 1010, New York, New York 10029. jaime.hyman@mountsinai.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Ambulatory Anesthesia / Pharmacology
Perioperative Medicine   |   June 2020
Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery: A Randomized Controlled Trial
Anesthesiology 6 2020, Vol.132, 1419-1428. doi:https://doi.org/10.1097/ALN.0000000000003286
Anesthesiology 6 2020, Vol.132, 1419-1428. doi:https://doi.org/10.1097/ALN.0000000000003286
Abstract

Background: Postdischarge nausea and vomiting after ambulatory surgery is a common problem that is not adequately addressed in current practice. This prospective, randomized, double-blind, parallel-group, placebo-controlled study was designed to test the hypothesis that oral olanzapine is superior to placebo at preventing postdischarge nausea and vomiting.

Methods: In a single-center, double-blind, randomized, placebo-controlled trial, the authors compared a single preoperative dose of olanzapine 10 mg to placebo, in adult female patients 50 years old or less, undergoing ambulatory gynecologic or plastic surgery with general anesthesia. All patients received standard antiemetic prophylaxis with dexamethasone and ondansetron. The primary composite outcome was nausea and/or vomiting in the 24 h after discharge. Secondary outcomes included severe nausea, vomiting, and side effects.

Results: A total of 140 patients were randomized and evaluable. The primary outcome occurred in 26 of 69 patients (38%) in the placebo group and in 10 of 71 patients (14%) in the olanzapine group (relative risk, 0.37; 95% CI, 0.20 to 0.72; P = 0.003). Severe nausea occurred in 14 patients (20%) in the placebo group and 4 patients (6%) in the olanzapine group (relative risk, 0.28; 95% CI, 0.10 to 0.80). Vomiting occurred in eight patients (12%) in the placebo group and two patients (3%) in the olanzapine group (relative risk, 0.24; 95% CI, 0.05 to 1.10). The median score for sedation (scale 0 to 10, with 10 being highest) in the 24 h after discharge was 4 (interquartile range, 2 to 7) in the placebo group and 6 (interquartile range, 3 to 8) in the olanzapine group (P = 0.023).

Conclusions: When combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 h after discharge from ambulatory surgery by about 60% with a slight increase in reported sedation.

Editor’s Perspective:

What We Already Know about This Topic:

  • Nausea and vomiting after discharge from ambulatory surgery remains common despite use of current antiemetics.

What This Article Tells Us That Is New:

  • The authors randomized women having day surgery to olanzapine 10 mg or placebo. All were also given both dexamethasone and ondansetron.

  • Olanzapine reduced nausea and vomiting in the 24 h after hospital discharge from 38% to 14%, corresponding to a number-needed-to-treat of just four patients.