Adding dexmedetomidine to morphine-based analgesia reduces early postoperative nausea in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial

Abstract

Background: Few studies have investigated the effect of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients underwent gynecological laparoscopic surgery. We investigated if adding dexmedetomidine to a morphine-based patient-controlled analgesia (PCA) could decrease the incidence of PONV in this high-risk patient population. Methods: In this prospective, randomized, double-blind and placebo-controlled study, 122 patients underwent gynecological laparoscopic surgery were assigned into two groups. Patients in the dexmedetomidine group (Group Dex) received a loading dose of dexmedetomidine 0.4 μg/kg before the end of surgery, followed by morphine 0.5 mg/ml plus dexmedetomidine 1 μg/ml for postoperative i.v. PCA. Patients in the control group (Group Ctrl) received normal saline before the end of surgery, followed by morphine 0.5 mg/ml alone for postoperative i.v. PCA. PCA pump was programmed as followed: bolus dose 2 ml, lockout interval 8 min and background infusion at a rate of 1 ml/h. The primary outcome was the incidence of nausea and vomiting within the first postoperative 24 h. Results: Although there were no significant differences in regard to the total incidence of PONV (41.0% vs 52.5%, P = 0.204), PONV score, time to first onset of PONV, or the need for rescue antiemetics within the first postoperative 24 h between the two groups, the incidence of nausea and total PONV during the first 2 h period was significantly lower in the Group Dex than in the Group Ctrl (9.8% vs 24.6%, P = 0.031 and 0.031, respectively). More patients in Group Dex were over sedated or had bradycardia during the PACU compared with Group Ctrl (P = 0.040 and 0.036, respectively). Conclusion: Our protocol in which dexmedetomidine was administered postoperativelyafter a loading doseto intravenous PCA morphine in patients undergoing gynecological laparoscopic surgery, had only early antiemetic effects, while no clinically meaningful antiemetic effect could be evidenced within the first 24 h after surgery.

Postoperative Nausea and Vomiting According to Target-Controlled or Manual Remifentanil Infusion in Gynecological Patients Undergoing Pelviscopic Surgery: A Randomized Controlled Trial

“…Finally, the patients were limited to those undergoing gynecological pelviscopic surgery, and the number of participants was relatively small. However, female patients, pelviscopic surgery, and intraoperative opioid use may increase the incidence of PONV [ 26 , 27 ]. The strength of this study is that it was conducted in patients expected to have a high incidence of PONV.…”

The Optimal Dose of Intraoperative Dexmedetomidine for Antiemetic Effects of Post-operative Nausea and Vomiting in Patients Undergoing Elective Thoracic Surgery: A Retrospective Cohort Study

“…Although some prospective studies with small sample sizes have shown that a 0.5 or 1.0 μg/kg bolus infusion could effectively decrease the incidence of PONV ( 7 – 9 , 15 , 16 ), there have been few studies on other doses, and it is not clear whether there was a dose-dependent antiemetic effect. The optimal dose of DEX for achieving antiemetic effects has not been well-documented.…”

Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

“…Geng ZY et al demonstrated that dexmedetomidine administration had lower incidence of nausea, which attributed to sympatholytic and opioid-sparing effect of dexmedetomidine [ 24 ]. The results from Li HJ et al showed that dexmedetomidine reduced the incidence of nausea not vomiting at 2 h after operation [ 25 ]. In our study, we observed that dexmedetomidine administration significantly decreased remifentanil requirement, postoperative pain VAS scores, and consumption of fentanyl.…”