Comparing the Incidence of Postoperative Nausea Vomiting (PONV) after Total Intravenous Anesthesia (TIVA) versus Volatile Maintenance Anesthesia (VMA): A Randomized Controlled Trial in Laparoscopic Cholecystectomy or Gynecological Laparoscopic Surgery

Abstract

Background: Postoperative nausea and vomiting (PONV) adversely affects the surgical outcome. According to the Apfel score, there is a direct correlation between anesthetic agents and PONV. Currently, it is well-known that PONV is higher in patients receiving volatile maintenance anesthesia (VMA) than those receiving total intravenous anesthesia (TIVA). The present study compared the incidence of PONV in moderate to high PONV risk patients between propofol and sevoflurane anesthesia. Objective: To study the incidence of early and delayed PONV among the patients with Apfel score >2 undergoing laparoscopic cholecystectomy (LC) or gynecological laparoscopic surgery comparing between TIVA and VMA techniques, from June to November 2019. Primary outcome was the incidence of PONV at the post-anesthesia care unit (PACU) and 24 hours after surgery. Secondary outcome was the incidence of intraoperative hypotension, extubation time and fentanyl consumption in PACU. Materials and Methods: A single-center, randomized controlled involving 75 patients with American Society of Anesthesiologists (ASA) 1 to 3, age 18 to 85 years, Apfel score >2 who underwent LC or gynecological laparoscopic surgery. Patients were randomly assigned to receive TIVA (n=36) or VMA (n=39). Intraoperative, TIVA were maintained with propofol 2 to 12 mg/kg/min, and VMA were maintained with exhaled sevoflurane of 1.5 to 2.5%. The bispectral index (BIS) was maintained between 40 and 60. Incidence(s) of early and delayed PONV were recorded. Results: Patient characteristics were similar in both groups. The incidence of PONV was not significantly different; early PONV: TIVA = 13.9%, VMA = 28.2% (p=0.131); delayed PONV: TIVA = 27.8%, VMA = 28.2% (p=0.967). For the secondary outcomes which are intraoperative hypotension (p=0.343), extubation time (p=0.598), and fentanyl consumption at PACU (p=0.855) were also not significantly different. Conclusion: There was no significant difference in PONV incidence between TIVA and VMA techniques in laparoscopic cholecystectomy or gynecological laparoscopic operation. © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2022