Amitabh Dutta1, Nitin Sethi2, Prabhat Choudhary3, Jayashree Sood4, Bhuwan Chand Panday2, Parul Takkar Chugh5. 1. Senior Consultant & Professor, Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India. 2. Consultant & Associate Professor, Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India. 3. Consultant, Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India. 4. Senior Consultant, Professor & Chairperson, Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India. 5. Biostatistician, Department of Research, Sir Ganga Ram Hospital, New Delhi, India.
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 kg-1 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 kg-1 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 kg-1 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.
RCT Entities:
OBJECTIVE:Postoperative nausea and vomiting (PONV) is commonly attributed to opioid analgesics; consequently, perioperative opioid dosage reduction is a common practice. However, inadequate fentanylanalgesia may have adverse implications (sympathetic activation, pain). We conducted this randomized clinical study to analyze whether preinduction fentanyl 3 µg kg-1 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 kg-1 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 kg-1 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.