Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T09:05:12.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Omitting fentanyl reduces nausea and vomiting, without increasing pain, after sevoflurane for day surgery*

Published online by Cambridge University Press:  01 October 2008

I. Smith ,
G. Walley  and
S. Bridgman
I. Smith*
Affiliation:
University Hospital of North Staffordshire, Department of Anaesthesia, Stoke-on-Trent, Staffordshire, UK
G. Walley
Affiliation:
University Hospital of North Staffordshire, Department of Postgraduate Medicine, Stoke-on-Trent, Staffordshire, UK
S. Bridgman
Affiliation:
University Hospital of North Staffordshire, Department of Postgraduate Medicine, Stoke-on-Trent, Staffordshire, UK
*
Correspondence to: Ian Smith, Directorate of Anaesthesia, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK. E-mail: damsmith@btinternet.com; Tel: 01782 553054; Fax: 01782 719754
Get access

Summary

Background and objective

Despite advantages of induction and maintenance of anaesthesia with sevoflurane, postoperative nausea and vomiting occurs frequently. Fentanyl is a commonly used supplement that may contribute to this, although it may alrove analgesia.

Methods

This double-blind study examined the incidence and severity of postoperative nausea and vomiting and pain in the first 24 h after sevoflurane anaesthesia in 216 adult day surgery patients. Patients were randomly allocated to either receive or not receive 1 μg kg−1 fentanyl, while a third group received dexamethasone in addition to fentanyl.

Results

Omission of fentanyl did not reduce the overall incidence of postoperative nausea and vomiting, but did reduce the incidence of vomiting and/or moderate to severe nausea prior to discharge from 20% and 17% with fentanyl and fentanyl-dexamethasone, respectively, to 5% (P = 0.013). Antiemetic requirements were reduced from 24% and 31% to 7% (P = 0.0012). Dexamethasone had no significant effect on the incidence or severity of postoperative nausea and vomiting. Combining the two fentanyl groups revealed further significant benefits from the avoidance of opioids, reducing postoperative nausea and vomiting and nausea prior to discharge from 35% and 33% to 22% and 19% (P = 0.049 and P = 0.035), respectively, while nausea in the first 24 h was decreased from 42% to 27% (P = 0.034). Pain severity and analgesic requirements were unaffected by the omission of fentanyl. Fentanyl did reduce minor intraoperative movement but had no sevoflurane-sparing effect and increased respiratory depression, hypotension and bradycardia.

Conclusion

As fentanyl exacerbated postoperative nausea and vomiting without an improvement in postoperative pain and also had adverse cardiorespiratory effects, it appears to be an unnecessary and possibly detrimental supplement to sevoflurane in day surgery.

Keywords

SURGERY AMBULATORYPOSTOPERATIVE NAUSEA AND VOMITINGSEVOFLURANEANAESTHESIA INHALATIONALFENTANYLPAIN ACUTE AND POSTOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 10 , October 2008 , pp. 790 - 799
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Two abstracts based on this work were presented at the Association of Anaesthetists’ annual scientific meeting in Aberdeen in September 2006 and published in Anaesthesia, March 2007.

References

1.Ghatge, S, Lee, J, Smith, I. Sevoflurane: an ideal agent for adult day-case anesthesia? Acta Anaesthesiol Scand 2002; 47: 917–931.CrossRefGoogle Scholar
2.Thwaites, A, Edmends, S, Smith, I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997; 78: 356–361.CrossRefGoogle ScholarPubMed
3.Smith, I, Thwaites, AJ. Inhalation versus TIVA in short duration anaesthesia. Acta Anaesthesiol Belg 1997; 48: 161–166.Google ScholarPubMed
4.Smith, I, Thwaites, AJ. VIMA and recovery with sevoflurane. Acta Anaesthesiol Scand 1998; 42 (Suppl 112): 219–221.Google Scholar
5.Smith, I, Terhoeve, PA, Hennart, D et al. A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol. Br J Anaesth 1999; 83: 564–570.CrossRefGoogle ScholarPubMed
6.Smith, I, Thwaites, AJ. Target-controlled propofol vs. sevoflurane: a double-blind, randomised comparison in day-case anaesthesia. Anaesthesia 1999; 54: 745–752.CrossRefGoogle ScholarPubMed
7.Joo, HS, Perks, WJ. Sevoflurane versus propofol for anesthetic induction: a meta-analysis. Anesth Analg 2000; 91: 213–219.CrossRefGoogle ScholarPubMed
8.Fleischmann, E, Akça, O, Wallner, T et al. Onset time, recovery duration, and drug cost with four different methods of inducting general anesthesia. Anesth Analg 1999; 88: 930–935.Google ScholarPubMed
9.Dashfield, AK, Birt, DJ, Thurlow, J, Kestin, IG, Langton, JA. Recovery characteristics using single-breath 8% sevoflurane or propofol for induction of anaesthesia in day-case arthroscopy patients. Anaesthesia 1998; 53: 1062–1066.CrossRefGoogle ScholarPubMed
10.Nathan, N, Peyclit, A, Lahrimi, A, Feiss, P. Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery. Can J Anaesth 1998; 45: 1148–1150.CrossRefGoogle ScholarPubMed
11.Fredman, B, Nathanson, MH, Smith, I, Wang, J, Klein, K, White, PF. Sevoflurane for outpatient anesthesia: a comparison with propofol. Anesth Analg 1995; 81: 823–828.Google ScholarPubMed
12.Shakir, AAK, Ramachandra, V, Hasan, MA. Day surgery postoperative nausea and vomiting at home related to peroperative fentanyl. J One-day Surg 1997; 6 (3): 10–11.Google Scholar
13.Sukhani, R, Vazquez, J, Pappas, AL, Frey, K, Aasen, M, Slogoff, S. Recovery after propofol with and without intraoperative fentanyl in patients undergoing ambulatory gynecologic laparoscopy. Anesth Analg 1996; 83: 975–981.CrossRefGoogle ScholarPubMed
14.Apfel, CC, Laara, E, Koivuranta, M, Greim, C-A, Roewer, N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693–700.CrossRefGoogle ScholarPubMed
15.Vandermeulen, EP. Controlling the stress response. In: White, PF, ed. Textbook of Intravenous Anesthesia. Baltimore: Williams and Wilkins, 1997: 565–579.Google Scholar
16.Borgeat, A, Wilder-Smith, OHG, Saiah, M, Rifat, K. Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg 1992; 74: 539–541.CrossRefGoogle ScholarPubMed
17.Gan, TJ, Glass, PSA. Balanced anesthesia. In: White, PF, ed. Textbook of Intravenous Anesthesia. Baltimore: Williams and Wilkins, 1997: 347–374.Google Scholar
18.Smith, I. Inhalational anesthetic agents. In: Hemmings, HC, Hopkins, PM, eds. Foundations of Anesthesia, 2nd ed.London: Elsevier, 2005: 311–321.Google Scholar
19.Smith, I. PONV associated with VIMA may be due to opioids; a prospective audit. J One-day Surg 2000; 10 (2): 12.Google Scholar
20.Henzi, I, Walder, B, Tramèr, M. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186–194.CrossRefGoogle ScholarPubMed
21.Matute, E, Alsina, E, Roses, R, Blanc, G, Pérez-Hernández, C, Gilsanz, F. An inhalation bolus of sevoflurane Versus an intravenous bolus of remifentanil for controlling hemodynamic responses to surgical stress during major surgery: a prospective randomized trial. Anesth Analg 2002; 94: 1217–1222.CrossRefGoogle ScholarPubMed
22.Smith, I. Cost considerations in the use of anaesthetic drugs. Pharmacoeconomics 2001; 19: 469–481.CrossRefGoogle ScholarPubMed
23.Russell, D, Wilkes, MP, Hunter, SC, Glen, JB, Hutton, P, Kenny, GNC. Manual compared with target-controlled infusion of propofol. Br J Anaesth 1995; 75: 562–566.CrossRefGoogle ScholarPubMed
24.Ashworth, J, Smith, I. Comparison of desflurane with isoflurane or propofol in spontaneously breathing ambulatory patients. Anesth Analg 1998; 87: 312–318.CrossRefGoogle ScholarPubMed
25.Coloma, M, Chiu, JW, White, PF, Armbruster, SC. The use of esmolol as an alternative to remifentanil during fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg 2001; 92: 352–357.CrossRefGoogle ScholarPubMed
26.Apfel, CC, Korttila, K, Abdalla, M et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. New Engl J Med 2004; 350: 2441–2451.CrossRefGoogle ScholarPubMed
27.Liu, K, Hsu, C-C, Chia, Y-Y. The effective dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg 1999; 89: 1316–1318.CrossRefGoogle ScholarPubMed
28.Fisher, DM. Surrogate endpoints. Are they meaningful? (Editorial). Anesthesiology 1994; 81: 795–796.CrossRefGoogle Scholar
29.Fisher, DM. Surrogate outcomes: meaningful not! (Editorial). Anesthesiology 1999; 90: 355–356.CrossRefGoogle ScholarPubMed
30.Tramèr, M, Moore, A, McQuay, H. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth 1996; 76: 186–193.CrossRefGoogle ScholarPubMed
31.Yogendran, S, Asokumar, B, Cheng, DCH, Chung, F. A prospective randomized double-blind study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80: 682–686.Google ScholarPubMed
32.Smith, I. Day surgery. In: Davies, N, Cashman, J, eds. Lee’s Synopsis of Anaesthesia, 13th ed.London: Elsevier, 2005: 581–591.Google Scholar