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The impact of preinduction fentanyl dosing strategy on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

Amitabh Dutta, MD, Nitin Sethi, DNB, Prabhat Choudhary, MD, Jayashree Sood, MD, Bhuwan Chand Panday, MD, Parul Takkar Chugh, MSc

Abstract


Objective: Postoperative nausea and vomiting (PONV) is commonly attributed to opioid analgesics; consequently, perioperative opioid dosage reduction is a common practice. However, inadequate fentanyl analgesia may have adverse implications (sympathetic activation, pain). We conducted this randomized clinical study to analyze whether preinduction fentanyl 3 μg kg1 administered by different techniques increases incidence of PONV.

Design: Randomized-control, prospective, investigator and observer blinded, two-arm, single-center comparison.

Setting: Operating room, postoperative ward.

Patients: Two hundred seventy patients, aged 20-60 years of either sex and belonging to ASA physical status I/II, scheduled to undergo laparoscopic cholecystectomy under general anesthesia.

Interventions: The patients were randomly allocated to receive preinduction fentanyl 3 μg kg1 administered by “single-bolus,” three equally divided “intermittent boluses” or a “short-infusion” technique.

Main outcome measures: The patients were evaluated for PONV profile (primary outcome); and postoperative parameters (pain, sedation, respiratory depression) (secondary outcome).

Results: Two hundred fifty-seven patients completed the study and 29.1 percent (n = 75) experienced PONV. The study groups were comparable for PONV incidence (“single-bolus”: n = 23, 25.8 percent; “intermittent-boluses”: n = 27, 32.5 percent; “short-infusion”: n = 25, 29.4 percent), total frequency of PONV (“single-bolus”: n = 28, 31.5 percent; “intermittent-boluses”: n = 39, 47.0 percent; “short-infusion”: n = 36, 42.4 percent), and frequency of rescue antiemetic usage (“single-bolus”: n = 24, 30.7 percent; “intermittent-boluses”: n = 28, 35.8 percent; “short-infusion”: n = 26, 33.3 percent). Patients who received preinduction fentanyl as “intermittent-boluses” were less sedated in the postoperative period (p < 0.001).

Conclusions: Controlled administration of preinduction fentanyl 3 μg kg1 by commonly employed administration methods does not seem to impact PONV profile. Further studies are needed to establish a temporal link between preinduction fentanyl and PONV.


Keywords


fentanyl, postoperative nausea, vomiting, laparoscopy

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References


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DOI: http://dx.doi.org/10.5055/jom.2018.0460

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