Prevention of postoperative nausea and vomiting with a subhypnotic dose of Propofol in patients undergoing lower abdominal surgery: A prospective, randomized, double-blind study

Authors

1 Department of Anesthesiology, Alzahra University Hospital, Isfahan, Iran

2 General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia in patients undergoing elective lower abdominal surgery. We aimed to compare the effect of a sub hypnotic dose of Propofol in the prevention of PONV after lower abdominal surgery with that of the conventional antiemetic drug Metoclopramide.
Materials and Methods: In this prospective, randomized, double-blind, placebo-controlled study, 104 patients with American Society of Anesthesiologists (ASA) class I or II status, aged 18-65 years, and undergoing elective lower abdominal surgery were randomized to one of four groups (n = 26 each). The patients in the four groups were administered intravenously Propofol 20 mg (G1), Propofol 30 mg (G2), Metoclopramide 10 mg (G3), and placebo (G4), 15 min before skin closure. All episodes of PONV during the first 24 h after anesthesia were recorded by an investigator who was blinded to treatment assignment.
Results: There were no significant differences between the treatment groups with regard to their gender, age, ASA class, duration of surgery, duration of recovery time and hospital stay, and also body mass index (BMI) (P > 0.05). The prevalence of PONV 0-6 h after anesthesia was 23.08% with Propofol 20 mg (P = 0.005), 15.38% with Propofol 30 mg (P = 0.016), 15.38% with Metoclopramide 10 mg (P = 0.016), compared to 30.77% with placebo (P = 0.005).
Conclusions: Administration of a subhypnotic dose of Propofol (30 mg) was found to be as effective as 10 mg Metoclopramide in reducing the incidence and severity of PONV in adult patients undergoing elective lower abdominal surgeries under Isoflurane-based anesthesia in the early postoperative period.

Keywords

1.
Lee DC, Kwak HJ, Kim HS, Choi SH, Lee JY. The preventative effect of ramosetron on postoperative nausea and vomiting after total thyroidectomy. Korean J Anesthesiol 2011;61:154-8.  Back to cited text no. 1
    
2.
Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract 2011;2011:748031.  Back to cited text no. 2
    
3.
Shinn HK, Lee MH, Moon SY, Hwang SI, Lee CS, Lim HK, et al. Post-operative nausea and vomiting after gynecologic laparoscopic surgery: Comparison between propofol and sevoflurane. Korean J Anesthesiol 2011;60:36-40.  Back to cited text no. 3
    
4.
Le TP, Gan TJ. Update on the management of postoperative nausea and vomiting and postdischarge nausea and vomiting in ambulatory surgery. Anesthesiol Clin 2010;28:225-49.  Back to cited text no. 4
    
5.
Griffiths JD, Gyte GM, Paranjothy S, Brown HC, Broughton HK, Thomas J. Iterventions for preventing nausea and vomiting in women undergoing regional anaesthesia for cesarean section. Cochrane Database Syst Rev 2012; 9:CD007579.  Back to cited text no. 5
    
6.
Safavi MR, Honarmand A. Low dose intravenous midazolam for prevention of PONV, in lower abdominal surgery-preoperative vs intraoperative administration. Middle East J Anesthesiol 2009;20:75-81.  Back to cited text no. 6
    
7.
Honarmand A, Safavi M, Khalili G, Mohammadnejad F. Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery. Saudi J Anaesth 2012;6:145-51.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Jabalameli M, Honarmand A, Safavi M, Chitsaz M. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron, and a combination. Adv Biomed Res 2012;1:2.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Safavi M, Honarmand A, Habibabady MR, Baraty S, Aghadavoudi O. Assessing intravenous ketamine and intravenous dexamethasone separately and in combination for early oral intake, vomiting and postoperative pain relief in children following tonsillectomy. Med Arh 2012;66:111-5.  Back to cited text no. 9
    
10.
Heidari SM, Talakoub R, Yaraghi Z. Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery. Adv Biomed Res 2012;1:9.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
Heidari SM, Saghaei M, Shafiee Z. Effect of preoperative volume loading on the intraoperative variability of blood pressure and postoperative nausea and vomiting. Med Arh 2012;66:94-6.  Back to cited text no. 11
    
12.
Heidari SM, Saryazdi H, Saghaei M. Effect of intravenous midazolam premedication on postoperative nausea and vomiting after cholecystectomy. Acta Anaesthesiol Taiwan 2004;42:77-80.  Back to cited text no. 12
    
13.
Diemunsch P, Diemunsch AM. Economics of antiemetics. Curr Opin Anaesthesiol 2002;15:233-7.  Back to cited text no. 13
    
14.
Klaiman P, Sternfeld M, Deeb Z, Roth Y, Golan A, Ezri T, et al. Magnetic acupressure for management of postoperative nausea and vomiting: A preliminary study. Minerva Anestesiol 2008;74:635-42.  Back to cited text no. 14
    
15.
Lee JW, Park HJ, Choi J, Park SJ, Kang H, Kim EG. Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy. Korean J Anesthesiol 2011;61:488-92.  Back to cited text no. 15
    
16.
Ajori L, Nazari L, Mazloomfard MM, Amiri Z. Effects of gabapentin on postoperative pain, nausea and vomiting after abdominal hysterectomy: A double blind randomized clinical trial. Arch Gynecol Obstet 2012;285:677-82.  Back to cited text no. 16
    
17.
Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intravenous anesthesia with propofol reduces postoperative nausea and vomiting in patients undergoing robot-assisted laparoscopic radical prostatectomy: A prospective randomized trial. Yonsei Med J 2012;53:1197-202.  Back to cited text no. 17
    
18.
Konstantopoulos K, Makris A, Moustaka A, Karmaniolou I, Konstantopoulos G, Mela A. Sevoflurane versus propofol anesthesia in patients undergoing lumbar spondylodesis: A randomized trial. J Surg Res 2013;179:72-7.  Back to cited text no. 18
    
19.
Levine PA, Bauchner H. Notice of retraction: "Prevention of postoperative nausea and vomiting with antiemetics in patients undergoing middle ear surgery: Comparison of a small dose of propofol with droperidol or metoclopramide" (Arch Otolaryngol Head Neck Surg. 2001;127[1]:25-28). Arch Otolaryngol Head Neck Surg 2012;138:692.  Back to cited text no. 19
    
20.
Ghimire A, Bhattarai B, Rahman TR, Singh SN, Koirala S, Tripathi M. Propofol sedation during spinal anaesthesia-a dose finding study. Kathmandu Univ Med J (KUMJ) 2011;9:170-3.  Back to cited text no. 20
    
21.
Kranke P, Röhm KD, Diemunsch P, Gan TJ, Apfel CC, Eberhart L, et al. Intravenous buspirone for the prevention of postoperative nausea and vomiting. Eur J Clin Pharmacol 2012;68:1465-72.  Back to cited text no. 21
    
22.
Esteve N, Valdivia J, Ferrer A, Mora C, Ribera H, Garrido P. Do anesthetic techniques influence postoperative outcomes? Part II. Rev Esp Anestesiol Reanim 2013;60:93-102.  Back to cited text no. 22
    
23.
Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intravenous anesthesia with propofol reduces postoperative nausea and vomiting in patients undergoing robot-assisted laparoscopic radical prostatectomy: A prospective randomized trial. Yonsei Med J 2012;53:1197-202.  Back to cited text no. 23
    
24.
Lee DW, Lee HG, Jeong CY, Jeong SW, Lee SH. Postoperative nausea and vomiting after mastoidectomy with tympanoplasty: A comparison between TIVA with propofol-remifentanil and balanced anesthesia with sevoflurane-remifentanil. Korean J Anesthesiol 2011;61:399-404.  Back to cited text no. 24
    
25.
Won YJ, Yoo JY, Chae YJ, Kim DH, Park SK, Cho HB, et al. The incidence of postoperative nausea and vomiting after thyroidectomy using three anaesthetic techniques. J Int Med Res 2011;39:1834-42.  Back to cited text no. 25
    
26.
Park SK, Cho EJ. A randomized controlled trial of two different interventions for the prevention of postoperative nausea and vomiting: Total intravenous anaesthesia using propofol and remifentanil versus prophylactic palonosetron with inhalational anaesthesia using sevoflurane-nitrous oxide. J Int Med Res 2011;39:1808-15.  Back to cited text no. 26
    
27.
Erdem AF, Yoruk O, Silbir F, Alici HA, Cesur M, Dogan N, et al. Tropisetron plus subhypnotic propofol infusion is more effective than tropisetron alone for the prevention of vomiting in children after tonsillectomy. Anaesth Intensive Care 2009;37:54-9.  Back to cited text no. 27
    
28.
Fujii Y. Management of postoperative nausea and vomiting in women scheduled for breast cancer surgery. J Anesth 2011;25:917-22.  Back to cited text no. 28
    
29.
Arslan M, Demir ME. Prevention of postoperative nausea and vomiting with a small dose of propofol combined with dexamethasone 4 mg or dexamethasone 8 mg in patients undergoing middle ear surgery: A prospective, randomized, double-blind study. Bratisl Lek Listy 2011;112:332-6.  Back to cited text no. 29
    
30.
Gecaj-Gashi A, Hashimi M, Sada F, Baftiu N, Salihu S, Terziqi H, et al. Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery. Adv Med Sci 2010;55:308-12.  Back to cited text no. 30
    
31.
Fujii Y, Itakura M. Comparison of propofol, droperidol, and metoclopramide for prophylaxis of postoperative nausea and vomiting after breast cancer surgery: A prospective, randomized, double-blind, placebo-controlled study in Japanese patients. Clin Ther 2008;30:2024-9.  Back to cited text no. 31
    
32.
Shinn HK, Lee MH, Moon SY, Hwang SI, Lee CS, Lim HK, et al. Post-operative nausea and vomiting after gynecologic laparoscopic surgery: Comparison between propofol and sevoflurane. Korean J Anesthesiol 2011;60:36-40.  Back to cited text no. 32
    
33.
Vanlersberghe C, Camu F. Propofol. Handb Exp Pharmacol 2008; (182):267-82:227-52.  Back to cited text no. 33
    
34.
Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. Paediatr Anaesth 2005;15:1094-7.  Back to cited text no. 34
    
35.
Unlugenc H, Guler T, Gunes Y, Isik G. Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2004;21:60-5.  Back to cited text no. 35
    
36.
Tramèr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: Quantitative systematic review of randomized controlled studies. Br J Anaesth 1997;78:247-55.  Back to cited text no. 36
    
37.
Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.  Back to cited text no. 37
    
38.
Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand 2002;46:921-8.  Back to cited text no. 38
    
39.
Smith HS. Opioid metabolism. Mayo Clin Proc 2009;84:613-24.  Back to cited text no. 39