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Effects of epidural anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial

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Abstract

Purpose

Patients undergoing laparoscopic gynecological surgery are susceptible to postoperative nausea and vomiting (PONV). We hypothesized that a combination of epidural and general anesthesia to minimize intraoperative opioid administration would reduce the incidence of PONV following laparoscopic gynecological surgery.

Methods

Women undergoing elective laparoscopic gynecological surgery were randomly assigned to receive general anesthesia alone (group G, n = 45) or general anesthesia with epidural anesthesia (group GE, n = 45). Patients in group G received fentanyl and remifentanil for intraoperative analgesia, and those in group GE received single-shot ropivacaine at the time of induction of anesthesia. The primary outcome was the incidence of PONV within 24 h of surgery. Secondary outcomes included the use of rescue metoclopramide within 24 h of surgery and the time to first incidence of PONV and first use of rescue metoclopramide.

Results

The incidence of PONV within 24 h of surgery was 60.0% in group G and 44.4% in group GE [relative risk (RR): 0.53, 95% confidence interval (CI): 0.23–1.23, p = 0.14]. There were no intergroup differences in the use of rescue metoclopramide (40.0% in group G, 24.4% in group GE, RR: 0.49, 95% CI 0.20–1.20, p = 0.11) and the time to first incidence of PONV and first use of rescue metoclopramide (p = 0.20 and 0.12, respectively).

Conclusion

Minimizing intraoperative opioid administration by combining epidural and general anesthesia did not reduce the 24-h incidence of PONV or rescue metoclopramide use after laparoscopic gynecological surgery.

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Author information

Author notes

  1. Hiroyuki Seki

    Present address: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

Authors and Affiliations

  1. Department of Anesthesiology, Tokyo Saiseikai Central Hospital, 4-17 Mita 1-chome, Minato-ku, Tokyo, 108-0073, Japan

    Hiroyuki Seki, Kyoko Furumoto, Aya Kagoya, Hiroka Hashimoto, Yoshihiro Sekiguchi & Itsuo Nakatsuka

  2. Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kyoko Furumoto

  3. Department of Anesthesiology, Keiyu Hospital, Yokohama, Kanagawa, Japan

    Masato Sato

Authors
  1. Hiroyuki Seki
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  2. Kyoko Furumoto
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  7. Itsuo Nakatsuka
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Correspondence to Hiroyuki Seki.

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Seki, H., Furumoto, K., Sato, M. et al. Effects of epidural anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial. J Anesth 32, 608–615 (2018). https://doi.org/10.1007/s00540-018-2525-5

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  • DOI: https://doi.org/10.1007/s00540-018-2525-5

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