[Effect of multimodal-antiemetic therapy on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy: a randomized controlled study]

Abstract

Objective: To evaluate the efficacy of multimodal-antiemetic therapy on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopy.

Methods: 129 patients scheduled for gynecological laparoscopy were randomly allocated to a multimodal-antiemetic group (group M, with 65 cases) or an ondansetron control group (group C, with 64 cases). In group M patients received a target-controlled infusion of propofol and remifentanil, prophylactic dexamethasone 10 mg and tropisetron 4 mg were given and parecoxib sodium 40 mg was used 30 minutes before the end of surgery. In group C patients received sevoflurane and 50% nitrous oxide. Prophylactic ondansetron 4 mg was given to patients 30 min before the end of surgery. The incidence of nausea and vomiting, use of rescue antiemetic drugs were recorded for 24 h.

Results: 24 h after surgery, the incidence of patients who suffered PONV was significantly lower in Group M compared with Group C (29% vs 70%, P < 0.05). At 0 - 2 h, 2 - 6 h, 6 - 24 h after surgery, the incidences of PONV were 8%, 6% and 25% for group M respectively, significantly lower than those for group C, which were 33%, 30% and 66% respectively(P < 0.05).

Conclusions: Multimodal-antiemetic therapy; a regimen including total intravenous anaesthesia with propofol and remifentanil, prophylactic antiemetic (dexamethasone at induction and tropisetron at end of surgery), and multimodal analgesia with parecoxib sodium could significantly reduce the incidence of PONV after gynecological laparoscopy.