Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery

• Published in: Acta anaesthesiologica Scandinavica Vol. 49; no. 3; pp. 305 - 311
• Main Authors: Rama-Maceiras, P., Ferreira, T. A., Molíns, N., Sanduende, Y., Bautista, A. P., Rey, T.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Publishing Ltd/Inc 01-03-2005; Blackwell
• Subjects: Adolescent; Adult; Aged; Analgesics, Opioid - therapeutic use; Androstanols - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Combined - adverse effects; Anesthetics, Combined - therapeutic use; Anesthetics, Intravenous - adverse effects; Anesthetics, Intravenous - therapeutic use; Antiemetics - therapeutic use; Biological and medical sciences; complications; Double-Blind Method; Female; fentanyl; Fentanyl - adverse effects; Fentanyl - therapeutic use; Humans; Intravenous anaesthesia; Male; Medical sciences; Metoclopramide - therapeutic use; Middle Aged; Morphine - therapeutic use; Neuromuscular Nondepolarizing Agents - therapeutic use; Piperidines - adverse effects; Piperidines - therapeutic use; postoperative nausea and vomiting; Postoperative Nausea and Vomiting - prevention & control; propofol; Propofol - adverse effects; Propofol - therapeutic use; Prospective Studies; Reconstructive Surgical Procedures - methods; remifentanil; Postoperative; Agonist; Intravenous administration; complications; Intravenous anaesthesia; μ Opioid receptor; Fentanyl; Opiates; Plastic surgery; Nausea; Narcotic analgesic; Remifentanil; postoperative nausea and vomiting; General anesthetic; Vomiting; Digestive diseases; Anesthesia; Complication; Propofol; Sedative; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2005.00650.x

Background:  The effect of different opioids on postoperative nausea and vomiting (PONV) has not been conclusively determined yet, thus the aim of this study was to compare the incidence of PONV in propofol‐anaesthetized patients receiving either fentanyl or remifentanil as opioid supplement.
Methods:  Sixty ASA physical status I and II patients scheduled for plastic surgery gave their written informed consent for this prospective, randomized, double‐blind study. Anaesthesia was induced with propofol, rocuronium and fentanyl (n = 30; 2 µg kg−1) or remifentanil (n = 30; 1 µg kg−1). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and an infusion of the opioid studied, which was modified according to clinical criteria. Baseline postoperative analgesia was achieved with intravenous propacetamol + metamizol. Intravenous morphine was given if visual analogic scale (VAS) for pain was ≥ 4 (scale 0–10) and metoclopramide was administered if a patient presented ≥ 2 PONV episodes (nausea or vomiting) in less than 30 min. Postoperatively (2, 12 and 24 h), we registered VAS, rescue morphine consumption, number of patients with episodes of PONV and number of patients requiring metoclopramide. P < 0.05 was considered significant.
Results:  There were no significant differences between groups in the demographic parameters, ASA physical status, propofol dose, VAS, and rescue morphine requirements. Fourteen patients in the fentanyl group and four in the remifentanil group presented PONV episodes 2–12 h postoperative hours' interval; (P < 0.05). Ten patients in the fentanyl group and four in the remifentanil group presented vomiting episodes in the same period (P < 0.05); and eight patients in the fentanyl group and one in the remifentanil group required metoclopramide; (P < 0.05). The number of postoperative PONV episodes were low, both in the 0–2‐h period (n = 2 vs. n = 1, fentanyl and remifentanil, respectively) and in the 12–24‐h period (n = 3 vs. n = 1).
Conclusion:  Propofol + fentanyl anaesthesia resulted in a higher incidence of PONV and requirements of antiemetic drugs in the period between 2 and 12 postoperative hours compared with propofol + remifentanil, in patients undergoing plastic surgery.