BJA Advance Access originally published online on April 15, 2005
British Journal of Anaesthesia 2005 94(6):835-839; doi:10.1093/bja/aei137
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Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia
Department of Anesthesiology, National Taiwan University Hospital, 7 Chung San South Road, Taipei, Taiwan
* Corresponding author. E-mail: wzsun{at}ntu.edu.tw
Background. This study was designed to examine the analgesic and dose-related antiemetic efficacy of diphenhydramine–morphine mixture for intravenous patient-controlled analgesia (PCA).
Methods. Healthy women, undergoing abdominal total hysterectomy were recruited to this double-blinded randomized placebo-controlled study. Patients were randomly allocated to one of three groups (n=40 each). In group 1, patients received saline at induction and morphine 1 mg ml–1 alone for postoperative PCA. Patients in groups 2 and 3 received diphenhydramine 30 mg i.v. at induction and were given a 1.2:1 or a 4.8:1 ratio, respectively, of diphenhydramine–morphine mixture for postoperative PCA.
Results. A total of 112 patients completed the study. The incidence of postoperative nausea (31.6% vs 67.6%, P<0.01) and vomiting (15.8% vs 40.5%, <0.05) was significantly lower in group 3 than in group 1. Furthermore, the incidence of severe nausea was significantly lower in group 3 than in group1 (2.6% vs 24.3%, P<0.05). The rescue antiemetic requirements were also significantly less in group 3 than in group 1 (5.3% vs 24.3%, P<0.05). However, there was no significant difference between group 2 and group 1 in any of the comparisons. Pain intensity, 24-h morphine consumption and diphenhydramine-related side-effects, such as sedation or dry mouth, did not differ among the three groups.
Conclusion. An initial bolus of diphenhydramine 30 mg at anaesthetic induction followed by postoperative PCA with a 4.8:1, but not 1.2:1, diphenhydramine–morphine mixture provides an effective antiemetic efficacy without morphine-sparing effects.
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