Effects of Menstrual Cycle on Postoperative Analgesic Requirements, Agitation, Incidence of Nausea and Vomiting after Gynecological Laparoscopy

Abstract

Background: Several studies have suggested that the menstrual cycle has an impact on postoperative nausea and vomiting (PONV). No previous study has evaluated the effect of the menstrual cycle on the incidence of postoperative agitation and analgesic/antiemetic requirements. Methods: On the basis of the phase of the menstrual cycle [pre±menstrual (Pd 25–6), early follicular phase (Pd 8–12), ovulatory phase (Pd 13–15), and luteal phase (Pd 20–24)], 67 patients enrolled in this blinded, prospective study. Anesthesia was standardized. Fentanyl was given to the patients who had severe pain in the recovery room. The patients who had agitation were given midazolam. When pain intensity was >5 on the Visual Analog Scale, metamizol was administered in the Gynecology Department. A blinded anesthesiologist recorded episodes of PONV in the recovery room, and 2 and 24 h postoperatively. Results: The opioid requirement and the frequency of agitation were similar in each group. Metamizol consumption was highest in the luteal phase (p < 0.05). The follicular and luteal phases were predictors for vomiting at recovery (p < 0.05 and p < 0.001, respectively). At the postoperative 2nd hour, nausea was higher in the follicular phase than in the other phases (p < 0.05) and the luteal phase was a predictor for retching (p < 0.001). At the postoperative 24th hour, nausea was the common symptom in the luteal phase (p < 0.05). The need for ondansetron was highest in the luteal phase (p < 0.01). Conclusions: In conclusion, we suggest that the scheduling of all surgical procedures according to the menstrual phase may serve to reduce the incidence of PONV and metamizol/ondansetron consumption and hospital costs.

Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study

“…In the early postoperative period, the incidence of nausea but not of vomiting was decreased during the luteal phase. The results of this study were similar to studies that suggested that the early phase of the cycle increases risk of PONV [9][10][11], but differed with those that determined that the luteal phase was a predictor of PONV [12,13] and likewise to those studies that found no influence of the cycle on PONV [14,16,17]. Small, single-center studies may not have enough power to answer the question, but a subsequent metaanalysis may be helpful.…”

“…While the follicular phase of the menstrual cycle increased the risk for PONV in some studies [9][10][11], the luteal phase increased the risk in another [12]. Moreover both phases, follicular and luteal increased the risk in one study [13] but not in a multicentre study [14] or a factorial trial of six interventions for the prevention of PONV (IMPACT study) [8] (Table 1).…”

Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study

“…Also, women are more susceptible to PONV, especially menstruating women, because of a higher level of sexual hormones (e.g., gonadotropin, and mainly progesterone) than in men [2,7,13,16,18]. It is also noteworthy that athletic patients and younger patients, especially children 11 to 16 years of age, are more susceptible to PONV, and the risk decreases with the patientÕs age [4,6,9,15].…”

Effects of the menstrual cycle on injection pain due to rocuronium

“…A large proportion of women report increases in pain-related symptoms at certain stages of the menstrual cycle [5]. Anesthetic, analgesic, and antiemetic requirements also change across the menstrual cycle [6][7][8]. Several factors have been suggested to explain this situation.…”