title: Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis.
abstract: OBJECTIVE
  We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.
  
  
  METHODS
  In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.
  
  
  RESULTS
  Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.
  
  
  CONCLUSIONS
  Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Bum
authors.initials: JB
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yon Hee
authors.initials: YH
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Youn-Woo
authors.initials: YW
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong Soo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong-Rim
authors.initials: JR
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. anezzang@yuhs.ac.
authors.forename: Chul Ho
authors.initials: CH
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D000077335:Desflurane; D005260:Female; D005283:Fentanyl / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects* / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000453:epidemiology*; D000077208:Remifentanil; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl
keywords: Analgesia; antiemetics; fentanyl; patient-controlled; postoperative nausea and vomiting