Intraoperative opioid use is not a risk factor for postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia with H1 antihistamines: a retrospective analysis

Background: : Opioids are generally considered a risk factor for postoperative nausea and vomiting (PONV). However, our clinical experience suggests that intraoperative fentanyl and remifentanil dosages, as well as tramadol use, were not risks of PONV in patients receiving intravenous patient-controlled analgesia (IVPCA) containing fentanyl and an H₁ antihistamine (PCA-H). Additionally, intraoperative use of an H₁ antihistamine does not appear to reduce the incidence of PONV in patients receiving PCA-H. We hypothesized that neither opioid use nor intraoperative H₁ antihistamine use would be associated with PONV in patients receiving PCA-H, and we investigated the incidence of and risk factors for PONV in these patients followng laparoscopic gynecological surgery. Methods: : We examined the incidence of PONV in patients receiving PCA-H after laparoscopic gynecological surgery under general anesthesia. Patient characteristics, anesthetic factors, and intraoperative prophylactic antiemetics were analyzed through multiple logistic regression to assess their relationships with PONV. Results: : A total of 1,778 patients were included, with 1,767 (99.4 %) receiving propofol-based anesthesia and 1,719 (96.7 %) received an intraoperative prophylactic antiemetic. Overall incidences of nausea, vomiting, and postoperative antiemetic use were 26.5 %, 8.7 %, 11.0 %, respectively. Intraoperative opioid use (fentanyl, remifentanil dose, or tramadol use) was not a risk factor for PONV. Additionally, intraoperative antihistamine use was ineffective. Conclusion: : Intraoperative doses of fentanyl, remifentanil, and the tramadol use were not PONV risk factors in patients receiving PCA-H under propofol-based anesthesia. Concurrent use of an intraoperative antihistamine was not associated with a further reduction in PONV among patients receiving PCA-H.