The impact of preinduction fentanyl dosing strategy on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

OBJECTIVE: Postoperative nausea and vomiting (PONV) is commonly attributed to opioid analgesics; consequently, perioperative opioid dosage reduction is a common practice. However, inadequate fentanyl analgesia may have adverse implications (sympathetic activation, pain). We conducted this randomized clinical study to analyze whether preinduction fentanyl 3 µg kg-1 administered by different techniques increases incidence of PONV.

DESIGN: Randomized-control, prospective, investigator and observer blinded, two-arm, single-center comparison.

SETTING: Operating room, postoperative ward.

PATIENTS: Two hundred seventy patients, aged 20-60 years of either sex and belonging to ASA physical status I/II, scheduled to undergo laparoscopic cholecystectomy under general anesthesia.

INTERVENTIONS: The patients were randomly allocated to receive preinduction fentanyl 3 µg kg-1 administered by "single-bolus," three equally divided "intermittent boluses" or a "short-infusion" technique.

MAIN OUTCOME MEASURES: The patients were evaluated for PONV profile (primary outcome); and postoperative parameters (pain, sedation, respiratory depression) (secondary outcome).

RESULTS: Two hundred fifty-seven patients completed the study and 29.1 percent (n = 75) experienced PONV. The study groups were comparable for PONV incidence ("single-bolus": n = 23, 25.8 percent; "intermittent-boluses": n = 27, 32.5 percent; "short-infusion": n = 25, 29.4 percent), total frequency of PONV ("single-bolus": n = 28, 31.5 percent; "intermittent-boluses": n = 39, 47.0 percent; "short-infusion": n = 36, 42.4 percent), and frequency of rescue antiemetic usage ("single-bolus": n = 24, 30.7 percent; "intermittent-boluses": n = 28, 35.8 percent; "short-infusion": n = 26, 33.3 percent). Patients who received preinduction fentanyl as "intermittent-boluses" were less sedated in the postoperative period (p < 0.001).

CONCLUSIONS: Controlled administration of preinduction fentanyl 3 µg kg-1 by commonly employed administration methods does not seem to impact PONV profile. Further studies are needed to establish a temporal link between preinduction fentanyl and PONV.