Intraoperative haloperidol does not improve quality of recovery and postoperative analgesia

Authors
Amin Ebneshahidi 1
Mojtaba Akbari 2
Masood Mohseni 3
1 Department of Anesthesiology, Persia Research Center, Isfahan, Iran
2 Department of Epidemiology, Persia Research Center, Isfahan, Iran
3 Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Introduction: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery.
Methods: Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6 th post-operative hour.
Results: The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05).
Conclusion: Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.

Keywords

1. Büttner M, Walder B, von Elm E, Tramèr MR. Is low-dose haloperidol a useful antiemetic?: A meta-analysis of published and unpublished randomized trials. Anesthesiology 2004;101:1454-63.  Back to cited text no. 1
    
2. Etezadi F, Najafi A, Yarandi KK, Moharari RS, Khajavi MR. ICU sedation with haloperidol-propofol infusion versus midazolam-propofol infusion after coronary artery bypass graft surgery: A prospective, double-blind randomized study. Ann Card Anaesth 2012;15:185-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3. Judkins KC, Harmer M. Haloperidol as an adjunct analgesic in the management of postoperative pain. Anaesthesia 1982;37:1118-20.  Back to cited text no. 3
    
4. Myles PS, Hunt JO, Nightingale CE, Fletcher H, Beh T, Tanil D, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999;88:83-90.  Back to cited text no. 4
    
5. Habib AS, Gan TJ. Food and drug administration black box warning on the perioperative use of droperidol: A review of the cases. Anesth Analg 2003;96:1377-9.  Back to cited text no. 5
    
6. Chu CC, Shieh JP, Tzeng JI, Chen JY, Lee Y, Ho ST, et al. The prophylactic effect of haloperidol plus dexamethasone on postoperative nausea and vomiting in patients undergoing laparoscopically assisted vaginal hysterectomy. Anesth Analg 2008;106:1402-6.  Back to cited text no. 6
    
7. Lisander B. Evaluation of the analgesic effect of metoclopramide after opioid-free analgesia. Br J Anaesth 1993;70:631-3.  Back to cited text no. 7
    
8. Kandler D, Lisander B. Analgesic action of metoclopramide in prosthetic hip surgery. Acta Anaesthesiol Scand 1993;37:49-53.  Back to cited text no. 8
    
9. Yamamoto S, Yamaguchi H, Sakaguchi M, Yamashita S, Satsumae T. Preoperative droperidol improved postoperative pain relief in patients undergoing rotator-cuff repair during general anesthesia using intravenous morphine. J Clin Anesth 2003;15:525-9.  Back to cited text no. 9
    
10. Cendán CM, Pujalte JM, Portillo-Salido E, Baeyens JM. Antinociceptive effects of haloperidol and its metabolites in the formalin test in mice. Psychopharmacology (Berl) 2005;182:485-93.  Back to cited text no. 10
    
11. Shir Y, Shenkman Z, Kaplan L. Neuropathic pain unrelieved by morphine, alleviated by haloperidol. Harefuah 1990;118:452-4.  Back to cited text no. 11
    
12. Sharma SK, Davies MW. Patient-controlled analgesia with a mixture of morphine and droperidol. Br J Anaesth 1993;71:435-6.  Back to cited text no. 12
    
13. Kest B, Mogil JS, Sternberg WF, Pechnick RN, Liebeskind J. Haloperidol increases pain behavior following peripheral tissue injury. Proc West Pharmacol Soc 1994;37:89-90.  Back to cited text no. 13
    
14. Cheng YF, Paalzow LK, Bondesson U, Ekblom B, Eriksson K, Eriksson SO, et al. Pharmacokinetics of haloperidol in psychotic patients. Psychopharmacology (Berl) 1987;91:410-4.  Back to cited text no. 14
    
15. Hassaballa HA, Balk RA. Torsade de pointes associated with the administration of intravenous haloperidol: A review of the literature and practical guidelines for use. Expert Opin Drug Saf 2003;2:543-7.  Back to cited text no. 15
    
16. Sharma ND, Rosman HS, Padhi ID, Tisdale JE. Torsades de Pointes associated with intravenous haloperidol in critically ill patients. Am J Cardiol 1998;81:238-40.  Back to cited text no. 16
    
17. Lee Y, Wang PK, Lai HY, Yang YL, Chu CC, Wang JJ. Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting. Can J Anaesth 2007;54:349-54.  Back to cited text no. 17
    
18. Aouad MT, Siddik-Sayyid SM, Taha SK, Azar MS, Nasr VG, Hakki MA, et al. Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery. Eur J Anaesthesiol 2007;24:171-8.  Back to cited text no. 18
    
 
Advanced Biomedical Research
Volume 2013, November
November 2013
Pages 1-4