Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Andemetic Prophylaxis

Purpose: We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONY) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT3)-receptor antagonist after the general anesthesia. Materials and Methods: In this retrospective study, incidence and risk factors for PONY were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. Results: Four hundred-forty patients (23%) Of 1878 had showed PONY. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONY (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONY long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONY If one, two, three, four, five, or six of these risk factors were present, the incidences of PONY were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONY Conclusion: Despite antiemetic prophylaxis with 5 HT3-receptor antagonist, 23% of patients with fentanyl-based 1V-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion, sickness or PONY). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONY was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.