Penehyclidine hydrochloride for treating postoperative nausea and vomiting after laparoscopic bariatric surgery: a double-blinded randomized controlled trial

Abstract

Background Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). Penehyclidine hydrochloride has been reported to be effective in preventing PONV. Considering the potential preventive effects of penehyclidine against PONV, we hypothesized that intravenous infusion of penehyclidine may alleviate PONV within the first 48 h in patients scheduled for LBS. Methods Patients who underwent LBS were randomly assigned (1:2) to receive saline (Control group, n = 113) or a single intravenous dose of penehyclidine 0.5 mg (PHC group, n = 221). The primary outcome was incidence of PONV within the first 48 h postoperatively. Secondary endpoints included severity of PONV, need for rescue antiemetic therapy, volume of water intake, and time to first flatus. Results PONV occurred in 159 (48%) patients within the first 48 h postoperatively, including 51% in the Control group and 46% in the PHC group. There was no significant difference in the incidence or severity of PONV between the two groups (P > 0.05). Within the first 24 h and 24–48 h, no significant difference was found in incidence or severity of PONV, postoperative nausea, postoperative vomiting, need for rescue antiemetic therapy, or volume of water intake (P > 0.05). Kaplan–Meier curves showed that penehyclidine was significantly associated with a prolonged time to first flatus (median onset time: 22 h vs. 21 h, P = 0.036). Conclusions Penehyclidine did not decrease incidence and severity of PONV in patients undergoing LBS. However, a single intravenous dose of penehyclidine (0.5 mg) was associated with a slightly prolonged time to first flatus. Trial registration Chinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893, date of registration: 25/10/2021).

Penehyclidine for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery Under Combined Intravenous and Inhalation Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Trial

“…13,14 Previous studies have shown that the mechanism of penehyclidine reducing the incidence of PONV is complex, which may be related to its blocking of the muscarinic acetylcholine receptor, which is involved in the development of PONV through various mechanisms. Recent clinical studies have shown that penehyclidine for prevention of PONV has made good progress in some surgical procedures, such as ophthalmology, 15 laparoscopic bariatric surgery, 16 thyroid surgery 17 and stomatology surgery. 18 Patients undergoing gynecological laparoscopic surgery are at high risk for PONV.…”

“…15 However, Ding et al found that penehyclidine (bolus 5mg, IV) did not reduce the incidence and severity of postoperative PONV in bariatric surgery patients. 16 In a study of patients undergoing gynecological laparoscopic surgery, Zhang et al observed that a single dose of penehyclidine before anesthesia also did not reduce the incidence of PONV. 27 Some of the above studies are based on a single dose of intravenous penehyclidine to investigate the prevention of PONV.…”

Postoperative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Gastrointestinal Surgery with Double Prophylactic Therapy

“…The combination of serotonin antagonists with dexamethasone is a common dual therapy used to prevent PONV for high-risk patients undergoing various surgical procedures, such as laparoscopic bariatric surgery (palonosetron 0.25 mg plus dexamethasone 10 mg), laparoscopic cholecystectomy (palonosetron 0.075 mg plus dexamethasone 8 mg), and cesarean delivery (palonosetron 0.075 mg plus dexamethasone 4 mg). 10 11 12 13 14 Even with double prophylaxis, PONV may still occur frequently. 5 15 Searching for factors related to PONV in various clinical situations may contribute to better PONV control.…”