The Utilization of Amisulpride as a Rescue Drug for Postop Patients Compared to Promethazine for the Treatment of Postoperative Nausea and Vomiting: An Educational Module

Abstract Background: Postoperative nausea and vomiting (PONV) persist as one of the most common adverse effects experienced by patients undergoing general anesthesia, as it can prolong a patient’s stay in the hospital, increase hospital costs, and lead to further complications delaying the recovery process.1,3,7 Despite prophylactic treatment with a combination of drugs, some patients still experience PONV. Despite its adverse side effects, Promethazine is still utilized as a rescue drug for PONV after failed prophylaxis. Objective: This quality improvement project aims to increase anesthesia providers’ knowledge of the current literature on Amisulpride\u27s efficacy and safety profile for treating PONV after failed prophylaxis compared to Promethazine. Methods: An in-depth analysis was conducted by using CINAHL, PubMed, Google Scholar, and the Cochrane Library database to obtain research studies discussing the use of Amisulpride and Promethazine as rescue treatments for failed PONV prophylaxis. CRNAs were invited to participate by completing an online pre-test survey, followed by viewing an online educational module, and a post-survey questionnaire to assess their acquired knowledge. Results: There was an increase in knowledge among anesthesia providers on using Amisulpride as a rescue treatment for failed prevention of PONV compared to Promethazine. Amisulpride has a safer profile and is less likely to cause any side effects, unlike Promethazine, which has the potential for multiple adverse effects. Discussion: Data collected from the surveys showed that anesthesia providers had increased their knowledge of the use, mechanism of action, and minimal potential for side effects of Amisulpride when used to treat PONV. A small sample size of 7 people and the online distribution were limitations for this project. Conclusion: Evidence-based research shows Amisulpride has a safer profile for treating PONV when prophylaxis fails compared to Promethazine. Results from this quality improvement project showed an increase in anesthesia providers’ knowledge regarding the benefits and adverse effects of both antiemetics. Introduction of Amisulpride to clinical practice can lead to improvements in patient outcomes by decreasing the occurrence of PONV and further complications. Keywords: Postoperative nausea and vomiting, prophylaxis, rescue, antiemetic, Amisulpride, Barhemsys, Promethazine, Phenerga