[Postoperative nausea and vomiting caused by epidural infusion following gynecological laparoscopic surgery: fentanyl and ropivacaine versus ropivacaine alone].
BACKGROUND
Patients who undergo gynecological laparoscopic surgery often begin to eat and ambulate soon after surgery. However, postoperative nausea and vomiting (PONV) can postpone recovery.


METHODS
We prospectively investigated the incidence of PONV, along with oral intake and ambulation in patients who received an epidural infusion following gynecological laparoscopic surgery with combined epidural and general anesthesia. Forty patients were randomly and equally divided into 2 groups: group R, who received patient-controlled epidural analgesia (PCEA) with 0.2% ropivacaine, and group FR, who received a continuous epidural infusion of 0.2% ropivacaine with fentanyl (CEA). PONV and pain were scored during the early (0-6 hours) and late (6-24 hours) postoperative periods.


RESULTS
PONV incidence and scores were significantly lower in group R (5.3%) than group FR (70.6%) during the late period. Further, patients in group R ate significantly more than group FR at both lunch and dinner, and 2 patients could not ambulate the day after surgery in the FR group. There was no significant difference in analgesia requested between the 2 groups.


CONCLUSIONS
We found that PCEA with ropivacaine alone resulted in a significantly lower incidence of PONV and did not disturb eating and ambulation following gynecological laparoscopic surgery, as compared to patients who received CEA.
Kawai
Kazumi
K
Department of Anesthesia and Intensive Care, Hiroshima City Asa Hospital, Hiroshima 731-0293.
Sanuki
Michiyoshi
M
Kinoshita
Hiroyuki
H
D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D013509:Gynecologic Surgical Procedures; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl