GYNECOLOGIC LAPAROSCOPIC SURGERY IS NOT ASSOCIATED WITH AN INCREASE OF SEROTONIN SECRETION

Abstract

S253 Gynecologic laparoscopic (GL) surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). Numerous studies have shown the beneficial effects of 5-HT3 antagonists in this setting 1, but the mechanism of action of the specific 5-HT3 antagonists after GL procedures is still not elucidated. After institutional ethics committee and written informed consent was obtained, 40 patients scheduled for elective laparoscopic (group A) or laparotomy (OL) (group B) were prospectively included in the study. Premedication, anesthetic techniques and postoperative pain treatment were standardized. The excretion of urinary 5-hydroxyindoacetic acid (5-HIAA) corrected to creatinine was measured in all patients immediately after induction of anesthesia and regularly repeated until the 9th hour following induction. The two groups were comparable with regard to demographic, although the ages were higher and the duration of surgery longer in group B (p<0.05). Postoperative morphine requirements were higher in group B (p<0.05). The excretion of 5-HIAA/creatinine was similar in both groups. The incidence of nausea was 50% and vomiting 35% in group A versus 60% for nausea and 15% for vomiting in group B (NS). The creation of a pneumoperitoneum during GL surgery is not associated with an increase of 5-HIAA excretion. We conclude that PONV after GL procedure is not explained by an increase of serotonin secretion. (Figure 1)Figure 1: Urinary excretion of 5-HIAA/creatinine in group A (GL) and B (OL) from t0 (= induction of anesthesia) to t9 (= 9 hours after induction). Results are expressed as mean +/- SD.