Combining propofol with morphine in patient-controlled analgesia to prevent postoperative nausea and vomiting

Abstract

We have studied the antiemetic effects of propofol when mixed with morphine in a patient-controlled analgesia (PCA) pump after major gynaecological surgery. In a double-blind, randomized, controlled study, 50 women, ASA I or II, received a standardized anaesthetic comprising thiopental, morphine, atracurium, nitrous oxide and oxygen with enflurane, and received postoperative PCA with morphine mixed with either 1% propofol or lvelip. The PCA bolus was morphine 1 mg with propofol 5 mg or lvelip 0.5 ml, with a lockout time of 5 min. Postoperative nausea and vomiting (PONV) were assessed by the nursing staff using a four-point ordinal scale and by the patient using a visual analogue scale for 48 h after surgery. The two groups were similar in the potential factors influencing the incidence of PONV. There were no significant differences between the two groups in any of the study measurements of PONV. There were, no side effects after propofol. Propofol, when mixed with morphine in this dose combination for PCA, did not decrease the incidence of nausea and vomiting in women undergoing major gynaecological surgery.

Propofol and gastric effects of morphine

“…Bree et al studied the antiemetic effects of propofol when mixed with morphine in a patient‐controlled analgesia (PCA) pump after major gynecological surgery. Propofol when mixed with morphine did not decrease the incidence of nausea and vomiting (20). In a study by Grattidge subhypnotic infusion of propofol had no antiemetic effect in patients receiving intrathecal morphine for pain relief after major arthroplasty (21).…”

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

“…Evaluation by Jadad's scoring system, operation (setting), number of subjects, dosing regimen of morphine, dosing regimen of the test drug, number of patients who developed nausea and/or vomiting, and eŠec-tiveness are shown in this table. The test drug was droperidol in 11 studies, 7,8,12,[16][17][18][19][20][21] metoclopramide in 5 studies, 9,10,16,21) dexamethasone in 6 studies, [22][23][24] propofol in 4 studies, [25][26][27][28] and ondansetron in 5 studies. 9,12,15,22) The results of testing the lack of homogeneity the results of studies for each of the four test drugs are shown.…”

Postoperative Nausea and Vomiting Are Strongly Influenced by Postoperative Opioid Use in a Dose-Related Manner

“…In populations that include a wide range of operative procedures, the incidence ranges from 22% to 52% (1,2). The incidence seems to increase in patients receiving patientcontrolled analgesia (PCA), where rates of 68%-100% for PON and POV have been recorded (3,4).…”