Postoperative Nausea and Vomiting and Postoperative Pain in Patients Undergoing Elective Laparoscopy; Comparison of Total Intravenous Anesthesia versus Inhalational Anesthesia: A Randomized Clinical Trial
Background: Two major complications of surgeries are postoperative nausea and vomiting (PONV) and also postoperative pain (POP). Several studies have compared total intravenous anesthesia (TIVA) with inhalational anesthesia regarding these two complications. Some results have shown a better postoperative recovery conditions, but other contradictory results can also be found.This study was performed to evaluate and compare the effect of inhalational and intravenous anesthesia in patients undergoing elective laparoscopic surgery, on the incidence and the severity of PONV and POP.
Methods: This study was performed as a single-blinded prospective clinical trial. All patients aged 18-65, with ASA class I and II who underwent elective laparoscopy were included. Patients were divided into two groups of intravenous anesthesia and inhalational anesthesia. The incidence and the severity of PONV and POP were examined in 5 separated times after the surgery. The use of a rescue antiemetic and analgesic medication were also evaluated.
Results: Overall, 67 patients received inhalational anesthesia and 55 patients received intravenous anesthesia. It was revealed that 47.8% of the patients in the inhalation group and 18.2% of the patients in the intravenous group developed PONV (P<0.001). The severity of PONV was significantly lower in the TIVA group (P<0.001), however, no statistically significant difference was found regarding the severity of abdominal pain (P=0.62).
Conclusion: The incidence of PONV and the need for administration of an antiemetic rescue drug are significantly lower in the TIVA group.
 Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012; 109(5):742-53.
 Kumar G, Stendall C, Mistry R, Gurusamy K, Walker D. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta‐analysis. Anaesthesia, 69(10): 1138-50.
 Wiesmann T, Kranke P, Eberhart L. Postoperative nausea and vomiting – a narrative review of pathophysiology, pharmacotherapy and clinical management strategies. Expert Opin Pharmacother. 2015; 16(7): 1069-77.
 Miaskowski C. A review of the incidence, causes, consequences and management of gastrointerstinal effects associated with postoperative opioid administration. J Perianesth Nurs. 2009; 24(2):222-8.
 Deitrick Ch L, Mick D J, Lauffer V, Prostka E, Nowak D, Ingersoll G. A Comparison of Two Differing Doses of Promethazine for the Treatment of Postoperative Nausea and Vomiting. J Perianesth Nurs. 2015; 30(1): 5-13.
 Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. 2014. Anesth Analg. 2014; 118(1):85-113.
 Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth Essays Res. 2016; 10(3):388-96.
 Arslan M, Arslan M, Çiçek R, Kalender HU, Yilmaz H. Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind Study. Curr Ther Res Clin Exp. 2011; 72(1): 1-12.
 Guo W, Ding J, Jin X, Li G. Effect of cerebral oxygen saturation on postoperative nausea and vomiting in female laparoscopic surgery patients. Medicine (Baltimore). 2017; 96(41):e8275.
 DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017; 357:j1455.
 Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011; 748031.
 Argoff CE. Recent management advances in acute postoperative pain. Pain Pract. 2014; 14(5):477-87.
 Pokkinen SM, Yli-Hankala A, Kalliomäki ML. The effects of propofol vs. sevoflurane on post-operative pain and need of opioid. Acta Anaesthesiol Scand. 2014; 58(8):980-5.
 Schraag S, Pradelli L, Alsaleh AJO, Bellone M, Ghetti G, Chung TL, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2018; 18(1):162.
 Mohaghegh T, Yazdi B, Norouzi A, Fateh S, Modir H, Mohammadbeigi A. Effect of intravenous anesthesia with propofol versus isoflurane inhalation anesthesia in postoperative pain of inguinal herniotomy: a randomized clinical trial. Med Gas Res. 2017; 7(2):86–92.
 Sabertanha A, Shakhsemampour B, Ekrami M, Allahyari E. Comparison of Infusion of Propofol and Ketamine-Propofol Mixture (Ketofol) as Anesthetic Maintenance Agents on Blood Pressure of Patients Undergoing Orthopedic Leg Surgeries. Anesth Pain Med. 2019; 9(6):e96998.
 Herling SF, Dreijer B, Wrist Lam G, Thomsen T, Møller AM. Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery. Cochrane Database Syst Rev. 2017; 4(4):CD011387.
 Peng K, Liu HY, Wu SR, Liu H, Zhang ZC, Ji FH. Does Propofol Anesthesia Lead to Less Postoperative Pain Compared With Inhalational Anesthesia?: A Systematic Review and Meta-analysis. Anesth Analg. 2016; 123(4):846-58.
 Kim TH, Choi B-M, Chin, J H, Lee MS, Kim DH, Noh GJ. The Reliability and Validity of the Rhodes Index of Nausea, Vomiting and Retching in Postoperative Nausea and Vomiting. Korean J Anesthesiol. 52(6):S59-S65.
 Akkurt BCO, Temiz M, Inanoglu K, Aslan A, Turhanoglu S, Asfuroglu Z, and Canbolant E. Comparison of Recovery Characteristics, Postoperative Nausea and Vomiting, and Gastrointestinal Motility with Total Intravenous Anesthesia with Propofol versus Inhalation Anesthesia with Desflurane for Laparoscopic Cholecystectomy: A Randomized Controlled Study. Current Therapeutic Research. 2009; 72 (9): 94-103.
 Holder-Murray J, Esper SA, Boisen ML, et al. Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens. Korean J Anesthesiol. 2019; 72(4):344-50.
 Lerman J, Jöhr, M. Inhalational anesthesia vs total intravenous anesthesia (TIVA) for pediatric anesthesia. Paediatr Anaesth. 2009; 19(5):521-34.
 Schaefer, MS, Kranke, P, Weibel, S, Kreysing, R, Ochel, J, Kienbaum, P. Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children: A systematic review and meta‐analysis. Pediatr Anesth. 2017; 27(12): 1202-9.
 Peach MJ, Lee BH, Evans SF. 2002. The effect of anesthetic technique on postoperative nausea and vomiting after day-case gynecological laparoscopy. Anaesth Intensive Care. 2002; 30(2):153-9.
 Shinn HK, Lee MH, Moon SY, Hwang S, Lee CS, Lim HK, et al. Post-operative nausea and vomiting after gynecologic laparoscopic surgery: comparison between Propofol and sevoflurane. Korean J Anesthesiology. 2011; 60(1): 36-40.
 Won YJ, Yoo JY, Chae YJ, Kim DH, Park SK, Cho HB, et al. The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques. J Int Med Res. 2011; 39(5): 1834-42.
 Wong SSC, Choi SW, Lee Y, Irwin MG, Cheung CW. The analgesic effects of intraoperative total intravenous anesthesia (TIVA) with propofol versus sevoflurane after colorectal surgery. Medicine (Baltimore). 2018; 97(31):e11615.
 Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intravenous anesthesia with propofol reduces postoperative nausea and vomiting in patients undergoing robot-assisted laparoscopic radical prostatectomy: a prospective randomized trial. Yonsei Med J. 2012; 53(6):1197-202.
 Erk G, Erdogan G, Sahin F, Taspinar V, Dikmen B. Anesthesia for laparoscopic cholecystectomy: comparative evaluation--desflurane/sevoflurane vs. propofol. Middle East J Anaesthesiol. 2007; 19(3):553-62.
 Voigt M, Fröhlich CW, Waschke KF, Lenz C, Göbel U, Kerger H. Prophylaxis of postoperative nausea and vomiting in elective breast surgery. J Clin Anesth. 2011; 23(6):461-8.
 Joe HB, Lee SY, Kim JS, Chang HS, Jeong Y, Jeong H, et al. Effect of total intravenous anaesthesia and prophylactic ramosetron on postoperative nausea and vomiting after thyroidectomy: A prospective, randomized controlled study. J Int Med Res. 2016; 44(1):81-8.
 Fassoulaki A, Melemeni A, Paraskeva A, Siafaka I, Sarantopoulos C. Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol. Anesth Analg. 2008; 107(5):1715-9.
 Fu-hai Ji, Dan Wang, Juan Zhang, Hua-yue Liu, and Ke Peng. Effects of propofol anesthesia versus sevoflurane anesthesia on postoperative pain after radical gastrectomy: a randomized controlled trial. J Pain Res. 2018; 11: 1247-54.
 Park SK, Cho EJ. 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. J Int Med Res. 2011; 39(5):1808-15.
|Issue||Vol 6 No 2 (2020): Spring|
|Postoperative nausea and vomiting Postoperative pain Inhalation anesthesia Intravenous anesthesia Laparoscopy|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|