FEELING QUEASY Researchers believe a common anti-psychosis drug could have prevented this patient's post-operative nausea.

Patients given a small intraoperative dose of an antipsychotic medication used to treat schizophrenia along with a common anti-nausea drug had significantly less post-operative nausea and vomiting (PONV) than patients given a placebo, reports a study in the American Society of Anesthesiologists' Online First edition of Anesthesiology.

Amisulpride, sold under the brand name Solian, is commonly used in Europe to manage psychosis and is currently under review by the U.S. Food and Drug Administration. The drug works by blocking dopamine signaling without inducing the irregular heart rhythms and drug-induced movement disorders that occurred when similar drugs were used to control nausea and vomiting in the past.

Researchers in Europe and the United States conducted a double-blind placebo-controlled study where patients with high-risk of PONV were given an anti-nausea drug (usually ondansetron or dexamethasone) along with 5mg of intravenously delivered amisulpride or a placebo. More than half (58%) of patients given amisulpride had no vomiting or need for fast-acting medication to prevent vomiting 24 hours after surgery. All PONV occurrences were lower in the amisulpride group. Only 14% had vomiting compared to 20% in the placebo, 50% had any nausea compared to 58% in the placebo, 37% had significant nausea compared to 48% in the placebo and 41% required fast-acting medication to stop vomiting compared to 49% in the placebo.

"This could enable improved control of PONV and allow for earlier mobilization and discharge of surgical patients," says lead author Peter Kranke, MD, in the ASA press release. "Patients with multiple risk factors for PONV require a multimodal approach for its prevention, including using a combination of anti-nausea drugs with different mechanisms of action, since it cannot be predicted which pathways will be active in a patient."

JoEllen McBride, PhD