Yonsei Med J.  2014 Sep;55(5):1430-1435. 10.3349/ymj.2014.55.5.1430.

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

• Choi JB
• Shim YH
• Lee YW
• Lee JS
• Choi JR
• Chang CH

• KMID: 1799513
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1430

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.

Keyword

Analgesia; antiemetics; fentanyl; patient-controlled; postoperative nausea and vomiting

MeSH Terms

Adult
Aged
Analgesia, Patient-Controlled/*adverse effects
Analgesics, Opioid/*adverse effects/therapeutic use
Antiemetics/administration & dosage/therapeutic use
Female
Fentanyl/*adverse effects/therapeutic use
Humans
Incidence
Isoflurane/adverse effects/*analogs & derivatives/therapeutic use
Male
Middle Aged
Piperidines/*adverse effects/therapeutic use
Postoperative Nausea and Vomiting/chemically induced/*epidemiology
Retrospective Studies
Risk Factors
Analgesics, Opioid
Antiemetics
Fentanyl
Isoflurane
Piperidines

Figure

• 

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

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