Preoperative Olanzapine and Quality of Recovery after Ambulatory Surgery: A Randomized Clinical Trial.

John Guzzi; Tom Gugel; Claudia Fernandez Robles; Adriana Herrera; Xiwen Zhao; Andrew Shapiro; Tiana Fernandez; Megan Longley; Alicia Stephan; Hang P Nguyen; Aryana Valedon; Christopher Tanaka; Selma Belkasim; Marguerite L Gilmore; Hung-Mo Lin; Jaime B Hyman

doi:10.1097/aln.0000000000006166

PubMed · 42160634

Preoperative Olanzapine and Quality of Recovery after Ambulatory Surgery: A Randomized Clinical Trial.

John Guzzi·Tom Gugel·Claudia Fernandez Robles·Adriana Herrera·Xiwen Zhao·Andrew Shapiro·Tiana Fernandez·Megan Longley·Alicia Stephan·Hang P Nguyen·Aryana Valedon·Christopher Tanaka·Selma Belkasim·Marguerite L Gilmore·Hung-Mo Lin·Jaime B Hyman

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Abstract

BACKGROUND: Postdischarge nausea and vomiting negatively impact recovery after surgery. Preoperative administration of 10 mg olanzapine decreases postdischarge nausea and vomiting but increases sedation. No data are available on the impact of olanzapine on global quality of recovery. METHODS: This was a single-center, randomized, double-blind, placebo-controlled trial in female patients 18 to 50 yr old undergoing ambulatory surgery during general anesthesia. Participants received 5 mg oral olanzapine or placebo in addition to antiemetic prophylaxis with dexamethasone and ondansetron. The primary outcome was Quality of Recovery-40 (QoR-40) on postoperative day (POD) 1. Secondary outcomes included QoR-40 on POD 2, postdischarge nausea (any and severe) through POD 2, and postanesthesia care unit length of stay. QoR-40 analyses used mixed-effects models adjusted for baseline preoperative QoR-40 scores. The group differences and corresponding 95% CI are reported. RESULTS: A total of 384 participants received olanzapine (n = 191) or placebo (n = 193). Compared with placebo, olanzapine was associated with higher QoR-40 scores on POD 1 (difference, 9.0 points; 95% CI, 6.1 to 11.8; P < 0.001). The POD 2 difference was 4.8 points (95% CI, 2.0 to 7.6; nominal P = 0.001), and this secondary outcome remained significant after false discovery rate correction. Olanzapine was associated with lower odds of any nausea (odds ratio [OR], 0.43; 95% CI, 0.28 to 0.66) and severe nausea (OR, 0.26; 95% CI, 0.14 to 0.48) on POD 1. On POD 2, olanzapine was associated with lower odds of any nausea (OR, 0.48; 95% CI, 0.30 to 0.76), but not severe nausea (OR, 0.65; 95% CI, 0.30 to 1.40). Postanesthesia care unit length of stay did not differ between groups. The significance of these prespecified secondary outcomes was unchanged after false discovery rate correction. CONCLUSIONS: When combined with dexamethasone and ondansetron, a single preoperative dose of 5 mg olanzapine improved global quality of recovery after discharge from ambulatory surgery.

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Humans Female Olanzapine Ambulatory Surgical Procedures Adult Double-Blind Method Middle Aged Postoperative Nausea and Vomiting Antiemetics Preoperative Care Young Adult Adolescent Dexamethasone Journal Article Randomized Controlled Trial

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John Guzzi, Tom Gugel, Claudia Fernandez Robles, Adriana Herrera, Xiwen Zhao, Andrew Shapiro, Tiana Fernandez, Megan Longley, Alicia Stephan, Hang P Nguyen, Aryana Valedon, Christopher Tanaka, Selma Belkasim, Marguerite L Gilmore, Hung-Mo Lin, Jaime B Hyman. 2026-05-20. Preoperative Olanzapine and Quality of Recovery after Ambulatory Surgery: A Randomized Clinical Trial.. https://doi.org/10.1097/aln.0000000000006166

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Journal Article; Randomized Controlled Trial resource Adolescent subject Adult subject Ambulatory Surgical Procedures subject Antiemetics subject Dexamethasone subject Double-Blind Method subject Female subject Humans subject Journal Article subject Middle Aged subject Olanzapine subject Randomized controlled trials study

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