title: Patient-controlled Analgesia With Propacetamol-Fentanyl Mixture for Prevention of Postoperative Nausea and Vomiting in High-risk Patients Undergoing Spine Surgery: A Randomized Controlled Trial.
abstract: BACKGROUND
  This randomized trial evaluated the effect of intravenous patient-controlled analgesia (IV-PCA) based on fentanyl mixed with either propacetamol or an equivalent volume of normal saline on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing spinal surgery.
  
  
  METHODS
  One hundred eight nonsmoking female patients were randomly and evenly allocated to receive IV-PCA with either propacetamol (4 g) or normal saline mixed to fentanyl (20 μg/kg). Primary study outcome was PONV incidence at 24 hours postsurgery. Secondary outcomes were nausea severity, pain intensity (100-mm visual analog scale), use of rescue antiemetics and analgesics, patient satisfaction, and adverse events at 6, 12, and 24 hours postsurgery.
  
  
  RESULTS
  Postsurgery, the propacetamol versus normal saline group had lower PONV incidence at 24 hours (41% vs. 66%, P=0.011); pain intensity at rest and rescue analgesic requirements at 6 to 12 hours (30±15 vs. 41±19, P=0.008; and 25% vs. 49%, P=0.036, respectively) and at 12 to 24 hours (25±15 vs. 35±17, P=0.008; and 19% vs. 42%, P=0.044, respectively); and higher patient satisfaction score (6.4±1.4 vs. 5.7±1.8, P=0.028).
  
  
  CONCLUSIONS
  In patients undergoing spinal surgery and at risk of developing PONV, continuous IV-PCA based on propacetamol mixed to fentanyl, relative to fentanyl alone, effectively reduced the incidence of PONV, pain intensity at rest, and additional use of rescue analgesics with higher patient satisfaction.
authors.affiliation: *Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul †Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Kim
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Sarah
authors.initials: S
authors.lastname: Soh
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Song
authors.forename: Se Ryeon
authors.initials: SR
authors.lastname: Lee
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000082:Acetaminophen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen; C063776:propacetamol; D005283:Fentanyl