title: Omission of fentanyl during sevoflurane anesthesia decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in major breast cancer surgery.
abstract: OBJECTIVE
  Our purpose was to investigate the effect of omission of fentanyl during sevoflurane anesthesia on the incidences of postoperative nausea and vomiting and on postanesthesia recovery in female patients undergoing major breast cancer surgery.
  
  
  METHODS
  Female patients (American Society of Anesthesiologists [ASA] physical status [PS] class I-II; age, 28-84 years) undergoing major breast cancer surgery were randomized to one of two anesthesia maintenance groups: sevoflurane-fentanyl anesthesia (SF; n = 25) or fentanyl-free sevoflurane anesthesia (S; n = 26). All patients were administered with propofol 2 mg x kg(-1) intravenously for anesthesia induction, a laryngeal mask airway was placed, and they received rectal diclofenac and local infiltration anesthesia. Anesthesia was maintained with sevoflurane in oxygen-air and they breathed spontaneously. The patients in group SF received fentanyl 0.1 mg intravenously and those in group S received normal saline during anesthesia.
  
  
  RESULTS
  Group SF revealed higher incidences of postoperative nausea (68% vs 27%) and vomiting (32% vs 8%) in the first 24 postoperative hours than group S. The median (25th-75th percentile) length of time from postanesthesia care unit (PACU) admission to ambulation was significantly longer in group SF (n = 23) at 195 min (158-219 min), than in group S, at 141 min (101-175 min). Two patients in group SF could not walk during the PACU stay.
  
  
  CONCLUSIONS
  Omission of fentanyl during sevoflurane anesthesia, combined with diclofenac and local infiltration anesthesia, decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in patients undergoing major breast cancer surgery.
authors.affiliation: Day Surgery Unit, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Gotaro
authors.initials: G
authors.lastname: Shirakami
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Teratani
authors.forename: Hajime
authors.initials: H
authors.lastname: Segawa
authors.forename: Shogo
authors.initials: S
authors.lastname: Matsuura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shichino
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D001943:Breast Neoplasms / Q000601:surgery*; D004008:Diclofenac / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control*; D012119:Respiration / Q000187:drug effects; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008738:Methyl Ethers; D004008:Diclofenac; D000077149:Sevoflurane; D005283:Fentanyl