Dopamine antagonists were used in the past for managing postoperative nausea and vomiting (PONV). However, their use for this purpose has declined owing to concerns over cardiac side effects.
In a study reported in Anesthesiology (online, 15 March 2018), researchers randomly assigned 1,147 surgical patients at high risk of PONV to the dopamine antagonist amisulpride (5mg intravenously) or placebo at induction of inhaled general anaesthesia. Patients also received one additional standard anti-emetic
The team found that 57.7% of those assigned to amisulpride did not experience vomiting or retching, or need rescue medication, in the 24-hour postoperative period compared with 46.6% of those assigned to placebo. Adverse events, including electrocardiogram abnormalities, were no more likely in the amisulpride group.
The researchers said the results indicate that amisulpride, which has been used widely as an antipsychotic in an oral formulation for the past 30 years in Europe, and at much higher doses, could also help the management of PONV.
 Kranke P, Bergese S, Minkowitz H et al. Amisulpride prevents postoperative nausea and vomiting in patients at high risk. Anesthesiology 2018. doi: 10.1097/ALN.0000000000002133