Postoperative Nausea and Vomiting in Opioid-Free Anesthesia Versus Opioid Based Anesthesia in Laparoscopic Cholecystectomy

Abstract

Background: Postoperative nausea and vomiting (PONV) is a usual complication in patients undergoing laparoscopic cholecystectomy. Minimized opioid use due to surgery has been shown to have a better effect on patient recovery after surgery. In this study we evaluate the effect of opioid free anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy. Materials and methods: 80 patients aged 20-65 years old were included in this randomized, clinical and prospective trial. The patients belonged to the ASA classifications 1 and 2 and were scheduled for laparoscopic cholecystectomy. Patients were classified into two groups: group 1 (fentanyl group- FG), which included 40 patients who received opioid anesthesia, and group 2 (opioid free anesthesia group-OFAG) which included 40 patients who received opioid free anesthesia. In patients from group 1 (fentanyl group -FG) introduction to general anesthesia consisted of giving midazolam at 0.04 mg/kg, fentanyl at 0.002 mg/kg, 2 mg/kg of propofol and 0.6 mg/kg of rocuronium bromide. These patients received fractionated bolus doses of fentanyl during surgery. Prior to general anesthesia these patients did not receive dexamethasone. The patients from group 2 (opioid free anesthesia group - OFAG) received dexamethasone at 0.1 mg/kg and 1 g of paracetamol before introduction to anesthesia as a pre-emptive analgesia. Introduction to anesthesia consisted of giving midazolam at 0.04 mg/kg, lidocaine at 1 mg/kg, propofol at 2 mg/kg, ketamine at 0.5 mg/kg, and 0.6 mg/kg of rocuronium bromide. Immediately after intubation, continuous intravenous infusion with lidocaine at 2 mg/kg/h and magnesium sulfate at 1.5 g/h was given. In this group, fentanyl was not given either during the introduction of anesthesia or during the intraoperative period. Immediately after extraction of the gallbladder patients from group 2 (OFAG) received 2.5 g of metamizole intravenously. PONV were recorded in the postoperative period of 24 hours after surgery. Results: There was no significant difference with respect to age, weight, sex, duration of surgery, and anesthesia time. PONV at different time intervals were statistically not significant at all postoperative time points – 1 hr, 4 hr, 8 hr, 12 hr and 24 hr after surgery in fentanyl group compared to opioid free anesthesia group. Even not statistically significant, PONV have occurred more often in patients who received opioid anesthesia. Conclusion: Postoperative nausea and vomiting occurs more often in patients who received opioids during laparoscopic cholecystectomy compared to patients who received opioid free anesthesia, but without statistical significance.

Comparative study of ambulatory versus inpatient laparoscopic cholecystectomy in Thailand: Assessing effectiveness and safety with a propensity score matched analysis

“…While previous studies have suggested that combining dexamethasone with an antiemetic is more effective than using antiemetic alone for reducing PONV [19], we chose to administer ondansetron alone for antiemetic purposes in our study. Although there are conflicting findings in previous studies regarding the effectiveness of local anesthetic injections [20,21] and opioid-free anesthesia [22,23] in reducing PONV, our study did not directly compare these approaches. Therefore, further research is warranted to clarify these points, and provide more comprehensive insights.…”

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

“…However, it was indicated that the pain score was significantly higher both at rest and coughing at 1 and 24 hours after surgery in the group with opioid anaesthesia. 35,36 Multimodal techniques for OFA anaesthesia were also developed by Jan Mulier and Igor Zadonsky. The newest 2020 modifications suggest premedication with 150 µg p.o.…”

“…However, it was indicated that the pain score was significantly higher both at rest and coughing at 1 and 24 hours after surgery in the group with opioid anaesthesia. 35 , 36 …”

“…Additionally, laparoscopic cholecystectomy is the dominant part of the surgery methods for chronic gallbladder stones and it consists 90% of surgical procedures. 31,35,36 The aim of study was to describe the role of the unique protocol of LOA in the main aspects of postoperative symptoms-nausea, vomiting, and pain control during general anaesthesia for laparoscopic cholecystectomy. The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole.…”

“…Additionally, laparoscopic cholecystectomy is the dominant part of the surgery methods for chronic gallbladder stones and it consists 90% of surgical procedures. 31 , 35 , 36 …”