Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis

Jong Bum Choi, Yon Hee Shim, Youn-Woo Lee, Jeong Soo Lee, Jong-Rim Choi, Chul Ho Chang, Jong Bum Choi, Yon Hee Shim, Youn-Woo Lee, Jeong Soo Lee, Jong-Rim Choi, Chul Ho Chang

Abstract

Purpose: We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.

Materials and methods: In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.

Results: Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.

Conclusion: Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.

Keywords: Analgesia; antiemetics; fentanyl; patient-controlled; postoperative nausea and vomiting.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Incidence of postoperative nausea and vomiting (PONV) during the first 48 h after surgery.

References

    1. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700.
    1. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652–658.
    1. Koivuranta M, Läärä E, Snåre L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia. 1997;52:443–449.
    1. Pierre S. Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: pro--'don't throw the baby out with the bathwater'. Eur J Anaesthesiol. 2011;28:160–163.
    1. Eberhart LH, Morin AM. Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: con--'life is really simple, but we insist on making it complicated'. Eur J Anaesthesiol. 2011;28:155–159.
    1. Kranke P. Effective management of postoperative nausea and vomiting: let us practise what we preach! Eur J Anaesthesiol. 2011;28:152–154.
    1. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88:659–668.
    1. Song JW, Park EY, Lee JG, Park YS, Kang BC, Shim YH. The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesia. Anaesthesia. 2011;66:263–267.
    1. Choi YS, Shim JK, Yoon DH, Jeon DH, Lee JY, Kwak YL. Effect of ramosetron on patient-controlled analgesia related nausea and vomiting after spine surgery in highly susceptible patients: comparison with ondansetron. Spine (Phila Pa 1976) 2008;33:E602–E606.
    1. White PF, Sacan O, Nuangchamnong N, Sun T, Eng MR. The relationship between patient risk factors and early versus late postoperative emetic symptoms. Anesth Analg. 2008;107:459–463.
    1. White PF, O'Hara JF, Roberson CR, Wender RH, Candiotti KA POST-OP Study Group. The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients. Anesth Analg. 2008;107:452–458.
    1. Moon YE, Joo J, Kim JE, Lee Y. Anti-emetic effect of ondansetron and palonosetron in thyroidectomy: a prospective, randomized, double-blind study. Br J Anaesth. 2012;108:417–422.
    1. Morad AH, Winters BD, Yaster M, Stevens RD, White ED, Thompson RE, et al. Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial. Clinical article. J Neurosurg. 2009;111:343–350.
    1. Apfel CC, Roewer N. Risk assessment of postoperative nausea and vomiting. Int Anesthesiol Clin. 2003;41:13–32.
    1. Macario A, Dexter F, Lubarsky D. Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane. Am J Health Syst Pharm. 2005;62:63–68.
    1. Lauta E, Abbinante C, Del Gaudio A, Aloj F, Fanelli M, de Vivo P, et al. Emergence times are similar with sevoflurane and total intravenous anesthesia: results of a multicenter RCT of patients scheduled for elective supratentorial craniotomy. J Neurosurg Anesthesiol. 2010;22:110–118.
    1. Tan T, Bhinder R, Carey M, Briggs L. Day-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane. Anesth Analg. 2010;111:83–85.
    1. Won YJ, Yoo JY, Chae YJ, Kim DH, Park SK, Cho HB, et al. The incidence of postoperative nausea and vomiting after thyroidectomy using three anaesthetic techniques. J Int Med Res. 2011;39:1834–1842.
    1. Höcker J, Tonner PH, Bollert P, Paris A, Scholz J, Meier-Paika C, et al. Propofol/remifentanil vs sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial. Anaesthesia. 2006;61:752–757.
    1. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted. Anesthesiology. 1999;91:109–118.
    1. Choi DH, Ko JS, Ahn HJ, Kim JA. A Korean predictive model for postoperative nausea and vomiting. J Korean Med Sci. 2005;20:811–815.
    1. Kim SH, Shin YS, Oh YJ, Lee JR, Chung SC, Choi YS. Risk assessment of postoperative nausea and vomiting in the intravenous patient-controlled analgesia environment: predictive values of the Apfel's simplified risk score for identification of high-risk patients. Yonsei Med J. 2013;54:1273–1281.
    1. Fero KE, Jalota L, Hornuss C, Apfel CC. Pharmacologic management of postoperative nausea and vomiting. Expert Opin Pharmacother. 2011;12:2283–2296.
    1. Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005;101:1343–1348.
    1. Anderson BJ, Ralph CJ, Stewart AW, Barber C, Holford NH. The dose-effect relationship for morphine and vomiting after day-stay tonsillectomy in children. Anaesth Intensive Care. 2000;28:155–160.
    1. Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology. 2003;98:46–52.
    1. Gan TJ. Postoperative nausea and vomiting--can it be eliminated? JAMA. 2002;287:1233–1236.
    1. East JM, Mitchell DI. Postoperative nausea and vomiting in laparoscopic versus open cholecystectomy at two major hospitals in Jamaica. West Indian Med J. 2009;58:130–137.
    1. Tramèr MR. Strategies for postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol. 2004;18:693–701.
    1. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–2451.

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