Influence of postoperative pain therapy on nausea and vomiting

PROBLEM: Postoperative nausea and vomiting remains an important problem. Many risk factors have been identified; however, the importance of postoperative analgesic technique and patient expectation remain poorly defined. METHODS: We prospectively collected data on postoperative nausea and vomiting (PONV) in four groups of randomly selected patients (n=50 per group) who received either simple analgesics, nurse-administered intravenous morphine (NAA), patient-controlled analgesia (PCA) with morphine or epidural analgesia with bupivacaine and fentanyl. Patients were questioned regarding any past history of PONV or motion sickness, their preoperative expectation of suffering PONV and satisfaction with their antiemetic therapy. RESULTS: The incidence of nausea was higher in both morphine groups P<0.05), women (P<0.05), those less than the median age of their group (P<0.05) and those with a past history of PONV (P<0.05) or motion sickness (P<0.05). Most patients did not expect to experience PONV (19.3%). The incidence of nausea was higher in those expecting to experience PONV than in those not expecting to suffer PONV (P<0.01). Of those who received postoperative antiemetic treatment, 23.6% were dissatisfied or very dissatisfied with their therapy. Few patients received a prophylactic antiemetic drug (15%). CONCLUSIONS: Study results show that patient expectation is a potent predictor of postoperative nausea, a risk factor hitherto ignored in the anaesthetic literature, and that, in the provision of analgesia following major surgery, epidural analgesia is associated with less PONV than intravenous morphine.     

Reduction in Pulmonary Embolism after Total Joint Arthroplasty: Three Years of Experience with Extended‐Release Epidural Morphine

A retrospective analysis of 659 patients who had undergone a hip or knee arthroplasty was undertaken to determine the incidence of pulmonary embolism (PE) during the 48‐hour period following surgery. Data related to pain control, concomitant medications, length of stay, and adverse reactions were also collated. Patients were evenly divided between those receiving extended‐release epidural morphine (EREM: n = 327; mean dose 9.7 mg, range 5 mg to 15 mg) or a control group receiving other treatment for postoperative pain (control: n = 332; 44% of controls had an epidural catheter in place). The incidence of PE was significantly higher in the control group than in the EREM group (control: n = 6 or 1.80% vs. EREM: n = 0). Pain control (by a 10‐point verbal numerical rating scale) was significantly improved in the EREM group compared with the control group 48 hours after surgery (2.3 ± 1.8 vs. 4.7 ± 2.6) and length of stay was significantly reduced (3.9 ± 1.5 days vs. 4.5 ± 2.0 days). Adverse event profiles of the EREM and control groups were consistent with prior published studies with EREM. The use of EREM following lower extremity joint arthroplasty may be associated with a significant reduction in the incidence of PE.     

Single-dose extended-release epidural morphine for pain following hip arthroplasty

This open-label, serial-cohort pilot study evaluated DepoDur, a new, single-dose, extended-release epidural morphine (EREM) for pain control after hip arthroplasty. Single-dose EREM (10-30 mg) or a single dose of standard morphine sulfate (MS) (5 mg) was administered before surgery and spinal anesthesia. Among the 39 patients enrolled, total 48-hour supplemental fentanyl use was lower (P = 0.011 overall treatment) and median time to first postoperative fentanyl use was three- to six-fold longer (P < 0.001 overall treatment), among 10-, 20-, and 30-mg single-dose EREM patients versus MS patients. EREM patients reported higher levels of satisfaction with pain intensity scores comparable to MS patients. Safety results were similar between groups. Single-dose EREM was generally safe and effective for treating postoperative pain and reduced the need for supplemental analgesia.     

地塞米松不同给药途径对吗啡硬膜外镇痛术后恶心呕吐的影响

目的 :研究地塞米松静脉给药与硬膜外给药对降低术后吗啡硬膜外镇痛恶心呕吐 (PONV)的作用是否存在不同。方法 :选择 15 0例硬膜外麻醉的妇科手术病例 ,随机分为 3组 ,手术结束前A组硬膜外腔注射 10mg地塞米松 ,B组静脉给予 10mg地塞米松 ,而C组不用地塞米松 (对照组 )。术毕所有病例均行吗啡联合小剂量氟哌利多硬膜外镇痛。观察 4 8h内恶心呕吐的发生率和严重程度 ,随访伤口感染或延迟愈合等情况。结果 :PONV发生率A组为 16 % ,B组为 8% ,两组无显著差异 (P >0 .0 5 ) ,均明显低于C组 (4 8% ) ,两组与C组相比均有显著差异 (P <0 .0 1)。未发生伤口感染或延迟愈合的病例。结论 :地塞米松10mg无论静脉给药还是硬膜外给药均能显著降低妇科手术后吗啡镇痛患者PONV的发生率 ,且单次给药无明显的不良反应     

布托啡诺联合恩丹西酮在直肠癌根治术后硬膜外吗啡镇痛中的抗瘙痒以及抗恶心呕吐作用

目的：考察术前联合应用恩丹西酮和布托啡诺,对接受硬膜外吗啡镇痛患者术后瘙痒及恶心呕吐的预防作用是否优于单药应用。方法：选择限期直肠癌根治手术的患者120例,随机分为4组。依据分组,手术消毒时,组1患者硬膜外注入吗啡2mg＋0.9%氯化钠液（共5mL）,组2硬膜外注入吗啡2mg＋布托啡诺1mg＋0.9%氯化钠液（共5mL）,组3硬膜外注入吗啡2mg＋0.9%氯化钠液（共5mL）,同时静脉给予恩丹西酮8mg,组4硬膜外注入吗啡2mg＋布托啡诺1mg＋0.9%氯化钠液（共5mL）,同时静脉给予恩丹西酮8mg。术后予患者自控硬膜卡镇痛（PCEA）持续镇痛,评定患者术后48h内的视觉模拟疼痛（VAS评分）、舒适度（BCS评分）、镇静（Ramesay评分）以及瘙痒、恶心呕吐的发生情况。结果：4组患者之间VAS、BCS及Ramesay评分均无显著差异（P〉0.05）,但组2,组3,组4出现需要治疗的瘙痒及恶心呕吐的发生率显著低于组1（P〈0.05）;另外,组4患者恶心呕吐的发生率显著低于组2（P〈0.05）,而且组4患者瘙痒的发生率显著低于组3（P〈0.05）。结论：布托啡诺联合恩丹西酮在不影响吗啡镇痛效果的同时,可以显著减少直肠癌患者根治术后恶心呕吐以及瘙痒的发生率,其效果明显优于单独用布托啡诺或者恩丹西酮,从而提高患者的满意度。     

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized,Double‐Blinded,Active Placebo‐Controlled Study

Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double‐blinded, placebo‐controlled study, and randomly assigned to receive 600 mg gabapentin or active placebo (12.5 mg diphenhydramine) orally within 2 hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient‐controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48 hours. Pain was also assessed at 3 months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P = 0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P > 0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P < 0.001). The frequency of patients experiencing pain at 3 months post‐thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P = 0.72). Conclusions: A single preoperative oral dose of gabapentin (600 mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.     

Pharmacological Prophylaxis and Management of Adult Postoperative/Postdischarge Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.     

Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: A dose-finding study

The present study investigated the dose relationship of ropivacaine with regard to analgesia and motor block when administered as a continuous 21 hour epidural infusion following major orthopaedic surgery.Forty six patients scheduled for elective total knee or hip arthroplasty were compared in this double-blind study. Patients were randomly assigned to one of four treatment groups: saline (n=12); ropivacaine 0.1% (n=11); ropivacaine 0.2% (n=12); ropivacaine 0.3% (n=11). Initial epidural analgesia was established with 0.5% ropivacaine and general anaesthesia was then induced for surgery. Within 30 minutes of the end of surgery, epidural infusions were commenced at a rate of 10 ml/hour for 21 hours. All patients had access to PCA morphine. Morphine consumption, VAS pain scores at rest, sensory and motor block and overall quality of treatment were assessed at regular intervals.The morphine consumption and VAS scores were lower overall in the ropivacaine groups than in the group receiving only PCA morphine. The difference was more evident during the first 8 hours of postoperative infusion, when significant differences between the ropivacaine 0.2% and 0.3% groups and the saline group were found. The incidence and degree of motor block were dose dependent. There was significantly higher patient satisfaction in all ropivacaine groups compared to the saline control group.In conclusion, 21 hour epidural infusion of ropivacaine, combined with PCA morphine, provides effective pain relief following major joint surgery and without significant adverse events. Morphine consumption and pain scores were lowest in the 0.3% ropivacaine group but this group had a higher degree of motor block. Pain relief with the combination of ropivacaine and PCA morphine is superior to that of PCA morphine alone.     

地塞米松对术后硬膜外吗啡引起恶心呕吐的预防作用

目的:评价地塞米松对硬膜外吗啡引起恶心呕吐的预防效果。方法:妇科肿瘤择期手术病人120例,随机双盲分为地塞米松(A)组、恩丹西酮(B)组、生理盐水(C)组三组,每组40人。当手术开始时,随机给予地塞米松10 mg或者恩丹西酮8 mg或者生理盐水2 mL。所有病人在手术结束前1 h均接受硬膜外吗啡2 mg,然后以0.125％布比卡因100 mL和吗啡0.12mg/kg维持硬膜外术后止痛48 h,评价镇痛效果、恶心呕吐。结果:A组和B组早期和晚期恶心呕吐发生率低于C组(P<0.05),而A组和B组无差别(P>0.05)。结论:地塞米松和恩丹西酮均能降低硬膜外吗啡引起的恶心呕吐,地塞米松对术后硬膜外吗啡引起的恶心呕吐有预防作用。     

Comparison of epidural analgesia and intercostal nerve cryoanalgesia for post‐thoracotomy pain control

Epidural analgesia is regarded as the gold method for controlling post‐thoracotomy pain. Intercostal nerve cryoanalgesia can also produce satisfactory analgesic effects, but is suspected to increase the incidence of chronic pain. However, randomized controlled trials comparing these two methods for post‐thoracotomy acute pain analgesic effects and chronic pain incidents have not been conducted previously. We studied 107 adult patients, allocated randomly to thoracic epidural bupivacaine and morphine or intercostal nerve cryoanalgesia. Acute pain scores and opioid‐related side effects were evaluated for three postoperative days. Chronic pain information, including the incidence, severity, and allodynia‐like pain, was acquired on the first, third, sixth and twelfth months postoperatively. There was no significant difference on numeral rating scales (NRS) at rest or on motion between the two groups during the three postoperative days. The patient satisfaction results were also similar between the groups. The side effects, especially mild pruritus, were reported more often in the epidural group. Both groups showed high incidence of chronic pain (42.1–72.1%), and no significance between the groups. The incidence of allodynia‐like pain reported in cryo group was higher than that in Epidural group on any postoperative month, with significance on the sixth and the twelfth months postoperatively (P<0.05). More patients rated their chronic pain intensity on moderate and severe in cryo group and interfered with daily life (P<0.05). Both thoracic epidural analgesia and intercostal nerve cryoanalgesia showed satisfactory analgesia for post‐thoracotomy acute pain. The incidence of post‐thoracotomy chronic pain is high. Cryoanalgesia may be a factor that increases the incidence of neuropathic pain.     

Urinary function during epidural analgesia with methadone and morphine in post-cesarean section patients

Urinary function was assessed in 120 women after cesarean section under epidural anesthesia. Postoperative analgesia was obtained by means of epidurally administered methadone (40 patients) or morphine (40 patients). In the remaining 40 women, no narcotic drugs were given and postoperative pain was treated with intramuscular or oral non-opiate analgesics and sedatives. Both methadone and morphine provided potent postoperative pain relief. Following epidural methadone, mean urine volumes of the first two postoperative voidings were increased (543 +/- 38 ml and 571 +/- 31 ml) as compared with those after epidural morphine (219 +/- 25 ml and 218 +/- 18 ml) and with those of patients receiving non-opiate analgesics (319 +/- 28 ml and 414 +/- 30 ml). The mean time interval between the end of surgery and first voiding following methadone analgesia was shorter (336 +/- 27 min) than after morphine (582 +/- 18 min) or after non-opiate (448 +/- 28 min) analgesic drugs. Difficulty in micturition and the need for bladder catheterization were also decreased in the group with epidural methadone (2.5%) in comparison with the groups receiving morphine (57.5%) or non-opiate analgesic medicaments (12.5%). The use of epidural methadone for postoperative pain relief is advocated, both in view of its analgesic potency and of the low incidence of urinary disturbances.     

A Multicenter,Randomized, Double‐Blind,Placebo‐Controlled Trial of Intravenous Ibuprofen (IV‐Ibuprofen) in the Management of Postoperative Pain Following Abdominal Hysterectomy

Background: Ibuprofen and other nonsteroidal anti‐inflammatory drugs are widely used to block pain and inflammation in a variety of settings. Contrarily, opioid analgesia does not block the inflammatory component of pain and the use of these agents can be accompanied by serious side effects. We conducted a multicenter, randomized, double‐blind, placebo‐controlled trial to evaluate the safety and efficacy of intravenous ibuprofen (IV‐ibuprofen) as a postoperative analgesic. Methods: A total of 319 patients were randomly assigned in a 1:1 ratio to receive 800 IV‐ibuprofen or placebo every 6 hours; in addition patients had access to morphine at a dose of 1–2 mg every 5 minutes. The primary outcome measure was median morphine consumption within the first 24 hours following surgery. Results: During the first 24 hours of treatment, the median morphine requirement was reduced by 19% (P ≤ 0.001) and resulted in a significant reduction in pain at rest (AUC, 6 to 24 hours and 12 to 24 hours, P < 0.001) and pain with movement (AUC, 6 to 24 hours, P = 0.010 and 12 to 24 hours, P ≤ 0.001) as measured by the visual analog scale (VAS) in patients receiving 800 mg IV‐ibuprofen compared to placebo. Time to ambulation was significantly faster (P = 0.018) in the IV‐ibuprofen treated group, as well. Similar treatment‐emergent adverse events occurred across both study groups and there was no difference in the overall incidence of these events. Conclusion: This study demonstrated that IV‐ibuprofen is an effective analgesic medication that is safe and well tolerated when administered as an 800 mg dose every 6 hours in patients undergoing total abdominal hysterectomy surgery.     

The role of prophylactic anti-emetic therapy in emergency department patients receiving intravenous morphine for musculoskeletal trauma

Objective : To determine if there is benefit in routine administration of the anti-emetic metoclopramide to patients receiving intravenous morphine for musculoskeletal trauma. Method : A randomized double-blind placebo controlled trial using 214 patients who presented to Dunedin Hospital Emergency Department with musculoskeletal trauma, requiring intravenous morphine for analgesia. Those recruited were randomized to two groups. Group one received placebo prior to morphine while those in group two received metoclopramide 10 mg intravenously, prior to morphine. Any vomiting or severe nausea within 2 h of receiving intravenous morphine was recorded. Results : The two groups were evenly matched for age, sex and morphine dose. Overall, 3.7% of patients in the study vomited (1.9% in the group receiving placebo and 5.4% in the group receiving metoclopramide). This difference was not significant (P = 0.17). The mean age was 78.5 years in the group that did vomit compared with a mean age of 46.0 years in those not vomiting. This difference was highly significant (P = 0.0009). Conclusion : The incidence of vomiting in patients receiving intravenous morphine for musculoskeletal trauma is low and the routine use of an anti-emetic in these patients is not justified. Intravenous metoclopramide in these patients does not reduce the incidence of vomiting.     

不同术后镇痛方法对老年患者认知功能的影响

目的探讨不同的术后镇痛方法对老年患者认知功能的影响的差异性,为提高老年患者术后生活质量,减轻认知功能扰乱提供依据。方法选择行腹部手术患者64例,年龄60岁以上术前无明显认知障碍,不合并脑血管疾患,无呼吸功能障碍,无肝肾功能障碍。实施连续硬膜外麻醉,随机分为2组,每组32例。经硬膜外自控镇痛组（PCEA组）：术后先给0．25％罗哌卡因6ml＋吗啡1～1．5mg＋氟哌利多1．25mg负荷镇痛剂量,尔后用100m10．25％罗哌卡因＋吗啡5mg＋氟哌利多2．5mg作术后2dPCEA。持续注入速率2．0ml／h,PCEA量1．0ml／次,锁定时间为15min。经外周静脉自控镇痛组（PCIA组）：吗啡1．0mg／ml＋氟哌利多0．2mg／ml,负荷镇痛剂量5．0ml,PCIA量1．0ml／次,持续注入速率1．0ml／h,锁定时间为15min。分别于术前、术后1d和3d进行认知功能测定。结果两组患者术后自控镇痛,其疼痛视觉评分无差异,均达到满意效果。术后1dPCIA组有近半数患者认知功能测试异常,与PCEA组比较：P〈0．01,PCIA术后镇痛对认知功能改变更加明显。由此说明,术后镇痛单从认知功能改变考量,PCEA较PCIA优越。结论PCIA与PCEA应用于老年患者下腹部手术术后镇痛,均能达到满意的术后镇痛,但PCIA影响术后认知功能较PCEA明显。因此,术后镇痛选用PCEA较PCIA优越。     

Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 μg/ml, 4 ml/h. Postoperative pain scores were assessed during cough on a categorical scale (0: no pain, 1: slight pain, 2: moderate pain, 3: severe pain) 24 and 48 h after surgery. Sum of pain scores (24 + 48 h assessments) was compared with time to first postoperative defaecation and LOS. Data from 19 patients were excluded because of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48 h, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3–6) versus low (0–2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery of gastrointestinal function and sufficient analgesia allowing discharge within 2–3 days in most patients after colonic resection.     

A randomised controlled trial on the efficacy and side‐effect profile (nausea/vomiting/sedation) of morphine‐6‐glucuronide versus morphine for post‐operative pain relief after major abdominal surgery*

Morphine is the first choice of treatment of severe post‐operative pain, despite the occurrence of often discomforting (post‐operative nausea or vomiting (PONV)) and sometimes dangerous (sedation, respiratory depression) side effects. Literature data indicate that morphine's active metabolite, morphine‐6‐glucuronide (M6 g), is a powerful analgesic with a possibly more favourable side‐effect profile. In this multi‐centre randomised controlled clinical trial patients undergoing major abdominal surgery were randomised to M6 g or morphine treatment. Treatment started 30–60 min prior to the end of surgery and was continued postoperatively, after patients were titrated to comfort, via patient‐controlled analgesia (PCA) for 24–48h. Pain intensity, nausea, vomiting and sedation scores were collected at regular intervals. In the study 268 patients were randomised to M6 g and 249 to morphine. Withdrawal due to insufficient pain relief occurred predominantly just after surgery and was higher in the M6 g group (16.8%) than in the morphine group (8.8%), suggesting a slower onset of analgesia for M6 g compared to morphine. Subjects who continued on PCA remained equi‐analgesic throughout the study. During the first 24 h, nausea levels showed a 27% difference in favour of M6 g which narrowly failed to reach statistical significance (P =0.052). Sub‐analysis showed a significant reduction in nausea levels in females on M6 g (30% difference, P =0.034). In all patients, similar reductions of 30–35% were observed in anti‐emetic use, vomiting, PONV (a combined measure of nausea and vomiting) in favour of M6 g, persisting for the first 24 h postoperatively. Reductions in sedation were observed in the first 4 h post‐operative period for M6 g patients.     

Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

BackgroundThe optimal effective dose of epidural morphine that provides postoperative analgesia after caesarean section with minimal side effects remains debated.AimsWe performed a systematic review to assess the analgesic efficacy and the incidence of adverse effects of epidural morphine after caesarean section compared to systemic analgesia with opioids.MethodsWe searched Medline, Embase and Cochrane Collaboration Library databases. Studies were evaluated with the Modified Oxford Scale. Prospective randomized studies comparing analgesic efficacy and/or adverse effects of a single epidural morphine administration versus systemic opioids after elective caesarean section were included.ResultsTen studies (n = 431) were selected. Epidural morphine increases the time until the first request for a rescue analgesic (Emax, 29.7 h; 95% confidence interval, 25.2–33.9) and decreases pain scores and postoperative morphine request during the first 24 h compared to systemic opioid analgesia. However, epidural morphine increases the incidence of pruritus (relative risk, 2.7; 95% CI, 2.1–3.6) and nausea (relative risk, 2.0; 95% CI, 1.2–3.3).ConclusionsA single bolus of epidural morphine provides better analgesia than parenteral opioids but with an effect limited to the first postoperative day after caesarean section and with an increase in morphine side effects.     

术后镇痛对剖宫产病人胃肠道动力的影响

目的 :研究不同药液对剖宫产术后镇痛病人胃肠道动力的影响。方法 :随机选择剖宫产术后硬膜外腔镇痛病人 90例。按术后镇痛所用不同药液随机分为 6组 ,每组 15例 ,测定术毕即刻 ,术毕 6h及 4 8h血浆胃动素 ,同时观察术后 4 8小时内恶心呕吐程度、频率及肛门首次排气时间。结果 :大剂量吗啡组术毕 6h胃动素水平明显高于其他组 (P <0 .0 5 ) ;其他组术后恶心呕吐程度及发生率明显低于大剂量吗啡组 (P <0 .0 5 ) ,加用胃复安两组间相比无明显差别 (C、D组 ) ,但与氟哌啶组 (A、B组 )相比 ,肛门排气时间明显缩短 (P <0 .0 5 )。结论 :吗啡术后镇痛引起消化道并发症可能与促进胃动素的合成及释放增加从而诱导胃体十二指肠不同步运动有关。     

A randomized controlled trial of two different interventions for the prevention of postoperative nausea and vomiting: total intravenous anaesthesia using propofol and remifentanil versus prophylactic palonosetron with inhalational anaesthesia using sevoflurane-nitrous oxide

Total intravenous anaesthesia (TIVA) can reduce the risk of postoperative nausea and vomiting (PONV) almost as much as a single antiemetic. This study compared TIVA (using propofol and remifentanil) with prophylactic palonosetron (a 5-hydroxytryptamine type 3 receptor antagonist) combined with inhalation anaesthesia using sevoflurane in 50% nitrous oxide, for the prevention of PONV. Patients were randomly assigned to one of two prophylactic interventions: (i) palonosetron 0.075 mg, intravenously before induction of inhalation anaesthesia (palonosetron group); and (ii) TIVA (propofol target blood concentration 2.5-6.0 μg/ml; remifentanil target blood concentration 2.5-6.0 ng/ml; TIVA group). Nausea/vomiting occurrence and severity were monitored immediately after the end of surgery for 24 h. The incidence of PONV was around 50% in both groups and the severity of nausea was similar in both groups. Prophylactic palonosetron with inhalational anaesthesia using sevoflurane in 50% nitrous oxide reduced the incidence of PONV after gynaecological laparoscopic surgery almost as much as TIVA using propofol and remifentanil.