Abstract PR458

Abstract

Background & Objectives: Postoperative nausea-and-vomiting (PONV) remains a difficult-to-treat negative outcome after general anaesthesia. For opioids are commonly blamed for PONV, perioperative dose reduction is a common practice. The incidence of PONV is higher in patients undergoing laparoscopic surgery. However, inadequate fentanyl analgesia may have adverse implications (sympathetic activation, brady/tachyarrhytmias). This randomized clinical study analyzed whether pre-induction fentanyl 3 µg kg-1 administered by different techniques increases incidence of PONV. Materials & Methods: 270 patient-participants, aged 20-60 years of either sex belonging to ASA-I/II,who underwent laparoscopic cholecystectomy under GA were randomly allocated to pre-induction fentanyl 3 µg kg-1 administered by ‘single-bolus’, three equally-divided ‘intermittent boluses’ or a ‘short-infusion’ technique. Primary (PONV profile) and secondary (pre-induction variables [hypopnea, need for oxygen supplementation], intraoperative hemodynamics, other postoperative parameters [pain, sedation, respiratory depression]) outcomes were analyzed. Results: 257-participants completed the study. About a third (29.1%, n=75) experienced PONV. The study groups were comparable for PONV incidence (‘single-bolus’: n=23, 25.8%; ‘intermittent-boluses’: n=27, 32.5%; ‘short-infusion’: n=25, 29.4%), frequency (‘single-bolus’: n=28, 31.5%; ‘intermittent-boluses’: n=39, 47.0%; ‘short-infusion’: n=36, 42.4%), and rescue anti-emetic usage (‘single-bolus’: n=24, 30.7%; ‘intermittent-boluses’: n=28, 35.8%; ‘short-infusion’: n=26, 33.3%). Significant secondary outcomes (p<0.001) included, higher incidence of hypopnea and shorter time to oxygen supplementation in the ‘pre-induction’ period in participants belonging to ‘single-bolus’ group and lower incidence of postoperative sedation in participants of ‘intermittent-boluses’ group. Conclusion: The controlled administration of pre-induction fentanyl 3 µg kg-1 by common intravenous administration methods does not seem to impact PONV. Within the scope of study methods, a temporal link between pre-induction fentanyl and PONV could not be established.