Advertisement

Journal of Anesthesia

, Volume 32, Issue 5, pp 781–785 | Cite as

Effect of remifentanil on postoperative nausea and vomiting: a randomized pilot study

  • Tatsunori Watanabe
  • Koji Moriya
  • Naoto Tsubokawa
  • Hiroshi Baba
Short Communication
  • 138 Downloads

Abstract

Opioid-related postoperative nausea and vomiting should not occur following remifentanil administration because of its relatively short time to elimination. However, studies have indicated that the incidence of postoperative nausea and vomiting associated with remifentanil is similar to that with other opioids. Hence, we aimed to determine whether intraoperative remifentanil itself is associated with postoperative nausea and vomiting when postoperative pain is managed without opioid use. In this prospective pilot study, 150 patients who underwent unilateral upper limb surgery under general anesthesia with brachial plexus block were included. Patients in the remifentanil and control groups received 0.5 µg/kg/min remifentanil and saline, respectively. Postoperative pain was managed using a brachial plexus block, non-steroidal anti-inflammatory drugs, and acetaminophen. The presence of postoperative nausea and vomiting within the first 24 h after anesthesia was assessed by an evaluator blinded to patient allocation. Eight patients were excluded from the final analysis, resulting in 72 and 70 patients in the remifentanil and control groups, respectively. Postoperative nausea and vomiting within 24 h after surgery occurred in 11 and 9 patients in the remifentanil and control groups, respectively. These data suggest that remifentanil use only minimally affects the incidence of postoperative nausea and vomiting under sevoflurane anesthesia.

UMIN Clinical Trials Registry identification number: UMIN000016110.

Keywords

Remifentanil Postoperative nausea and vomiting Pilot study 

Notes

Acknowledgements

Assistance with the study: we thank Dr Takahiro Tanaka (Department of Quality Control, Niigata University Medical and Dental Hospital Clinical and Translational Research Centre, Niigata, Japan) for providing technical assistance with the statistical analysis.

Funding

No external funding was received for the present study.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no conflict of interest.

References

  1. 1.
    Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–98.CrossRefGoogle Scholar
  2. 2.
    Egan TD, Lemmens HJ, Fiset P, Hermann DJ, Muir KT, Stanski DR, Shafer SL. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology. 1993;79:881–92.CrossRefGoogle Scholar
  3. 3.
    Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N, Investigators I. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–51.CrossRefGoogle Scholar
  4. 4.
    Gaszynski TM, Strzelczyk JM, Gaszynski WP. Post-anesthesia recovery after infusion of propofol with remifentanil or alfentanil or fentanyl in morbidly obese patients. Obes Surg. 2004;14:498–503 (discussion 4).CrossRefGoogle Scholar
  5. 5.
    Del Gaudio A, Ciritella P, Perrotta F, Puopolo M, Lauta E, Mastronardi P, De Vivo P. Remifentanil vs fentanyl with a target controlled propofol infusion in patients undergoing craniotomy for supratentorial lesions. Minerva Anestesiol. 2006;72:309–19.PubMedGoogle Scholar
  6. 6.
    Bekker AY, Berklayd P, Osborn I, Bloom M, Yarmush J, Turndorf H. The recovery of cognitive function after remifentanil-nitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients. Anesth Analg. 2000;91:117–22.PubMedGoogle Scholar
  7. 7.
    Watanabe T, Moriya K, Yoda T, Tsubokawa N, Petrenko AB, Baba H. Risk factors for rescue analgesic use on the first postoperative day after upper limb surgery performed under single-injection brachial plexus block: a retrospective study of 930 cases. JA Clin Rep. 2017;3:39.CrossRefGoogle Scholar
  8. 8.
    Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, Heineck R, Greim CA, Roewer N. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88:659–68.CrossRefGoogle Scholar
  9. 9.
    Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, Tramer MR, Society for Ambulatory A. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118:85–113.CrossRefGoogle Scholar
  10. 10.
    Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45:626–9.CrossRefGoogle Scholar
  11. 11.
    Hagemann E, Halvorsen A, Holgersen O, Tveit T, Raeder JC. Intramuscular ephedrine reduces emesis during the first three hours after abdominal hysterectomy. Acta Anaesthesiol Scand. 2000;44:107–11.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Tatsunori Watanabe
    • 1
    • 2
  • Koji Moriya
    • 2
  • Naoto Tsubokawa
    • 2
  • Hiroshi Baba
    • 3
  1. 1.Department of AnesthesiologyNiigata University Medical and Dental HospitalNiigataJapan
  2. 2.Niigata Hand Surgery FoundationSeiroJapan
  3. 3.Division of AnesthesiologyNiigata University Graduate School of Medical and Dental SciencesNiigataJapan

Personalised recommendations