title: Antiemetic effects of midazolam added to fentanyl-ropivacaine patient-controlled epidural analgesia after subtotal gastrectomy: A prospective, randomized, double-blind, controlled trial.
abstract: BACKGROUND
  Nausea and vomiting are frequent adverse effects of patient-controlled epidural analgesia (PCEA) with opioids.
  
  
  OBJECTIVE
  This study was designed to assess the antiemetic effect of midazolam added to fentanyl-ropivacaine PCEA.
  
  
  METHODS
  In a prospective, randomized, double-blind, controlled trial, smoking patients with gastric cancer undergoing elective subtotal gastrectomy were evenly allocated to 1 of 2 treatment groups to manage postoperative pain: 0.2% ropivacaine mixed with fentanyl 4 μg/mL and midazolam 0.2 mg/mL (test group) or 0.2% ropivacaine mixed with fentanyl 4 μg/mL (control group). The PCEA infusion was set to deliver 4 μL/h of the study solution, with a bolus of 2 mL per demand and a 15-minute lockout time. The incidence of postoperative nausea and vomiting (PONV), pain intensity, sedation score, usage of rescue analgesia and rescue antiemetic, respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, 48, and 72 hours after surgery. Total infused volume of PCEA at 72 hours after surgery was measured.
  
  
  RESULTS
  A total of 60 patients were approached and randomized to treatment. No patients were excluded by exclusion criteria and all enrolled patients completed this study. Incidence of nausea (7% vs 33%; P = 0.02) in the test group was significantly lower than in the control group. The overall frequency of PONV in the test group was significantly less than that of the control group (7% vs 40%; P = 0.006). In addition, the mean (SD) infused volume of PCEA in the test group was significantly lower than that in the control group (392.3 [68.9] vs 351.2 [49.8] mL; P = 0.01). However, there were no significant differences in pain intensity, usage of rescue antiemetics and rescue analgesics, and mild pruritus between groups. No patient reported moderate or severe sedation, respiratory depression, or hypoxemia. In addition, there were no severe adverse events.
  
  
  CONCLUSIONS
  Midazolam added to fentanyl-ropivacaine PCEA was associated with a significant reduction in the incidence of PONV compared with fentanyl-ropivacaine alone, and a significant decrease in the amount of PCEA administered without a significant increase in adverse events in these patients who underwent subtotal gastrectomy.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Sioh
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Jeongwon
authors.initials: J
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Jeon
keywords: epidural analgesia; fentanyl; midazolam; nausea and vomiting