Abstract
Background:Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).Objectives:This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.Methods:We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.Results:Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%]vs.45[10.4%],P= 0.002) and POD1 (60[19.0%]vs.59[13.6%],P= 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49vs.3.13 ± 1.53,P= 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75vs. 0.21 ± 0.62,P= 0.027) and rescue anti-emetics (27 [17.2%]vs. 15 [9.6%],P= 0.047) on POD 0 were both lower in the group P.Conclusion:In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.
Highlights
Postoperative Nausea and Vomiting (PONV), with the incidence reported to be 18-80%, is a common side effect in patients who undergo operation under general anesthesia [1 - 3]Post-Operative Nausea and Vomiting (PONV) causes a lot of discomfort to patients undergoing surgery, and can increase the length of hospital stay and overall medical cost [4].The risk factors of PONV can be divided into three main categories
Because opioid containing Intravenous (IV) PatientControlled Analgesia (PCA) is often used for pain control after laparoscopic gynecologic surgeries, it can increase the incidence of PONV
Glycopyrrolate premedication was found to be beneficial in terms of necessities for rescue antiemetics at Postoperative Day (POD) 0 as well as Numerical Rating Scale (NRS) score for nausea at POD 0 after Propensity Score Matching Method (PSM)
Summary
Postoperative Nausea and Vomiting (PONV), with the incidence reported to be 18-80%, is a common side effect in patients who undergo operation under general anesthesia [1 - 3]. The risk factors of PONV can be divided into three main categories. Patients undergoing laparoscopic abdominal surgery have a high risk for PONV due to pneumoperitoneum and residual gas effect after surgery [6]. PONV risk in laparoscopic gynecologic surgery is especially increased because patients are all females [5]. Because opioid containing Intravenous (IV) PatientControlled Analgesia (PCA) is often used for pain control after laparoscopic gynecologic surgeries, it can increase the incidence of PONV. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV)
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