Drug Design, Development and Therapy (Jun 2025)

Effect of High Maintenance Dose Versus Low Dose of Remifentanil on Incidence of Postoperative Nausea and Vomiting (PONV) in Patients Under Gynecological Laparoscopic Procedure: A Pilot Study

  • Liu ZY,
  • Yang XY,
  • Lv C,
  • Ye L,
  • Chen JJ,
  • Chen XY,
  • Wang SP,
  • Wu L,
  • Zhang WQ,
  • Lu M,
  • Guo XW

Journal volume & issue
Vol. Volume 19, no. Issue 1
pp. 4885 – 4894

Abstract

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Zao-Yu Liu,* Xin-Yu Yang,* Chen Lv, Ling Ye, Jia-Jia Chen, Xin-Yuan Chen, Shi-Ping Wang, Li Wu, Wei-Qiao Zhang, Man Lu, Xiao-Wen Guo Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiao-Wen Guo, Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310003, People’s Republic of China, Email [email protected]: The aim of this trial was to investigate postoperative nausea and vomiting (PONV) incidence between low- and high-dose remifentanil with propofol for total intravenous anaesthesia (TIVA) in adult female patients with gynecologic laparoscopy.Patients and Methods: The randomized clinical trial consisted of two groups: 0.1ug/kg/min remifentanil (L group) (n=39) and 0.4ug/kg/min remifentanil (H group) (n=40). Both of them was titrated with propofol to maintain bispectral index (BIS) values between 40 and 60. Forty-eight-hour PONV and postoperative visual analogue scale (VAS) and haemodynamic parameters and recovery quality and the concentrations of propofol TCI during the intraoperative periods were evaluated.Results: PONV incidences at 2, 6, 24, and 48 hours were 12.5%, 15%, 20% and 20% in (H group) and 25.6%, 25.6%, 25.6%, and 25.6% in (L group), but no statistical difference between groups (all P values > 0.05). H group reduced propofol use and recovery time (6.5 ± 4.8 versus. 8.7 ± 4.4 P = 0.036) but increased norepinephrine requirements (0 (0, 8) vs 0 (0, 0) P = 0.005). PCA use and first analgesic request time were similar.Conclusion: High-dose remifentanil regimens for TIVA would not increase the incidence of PONV, however, significantly reduce the demand for propofol, and promote rapid recovery of patients.Keywords: high-dose remifentanil, propofol, postoperative nausea and vomiting, PONV, hyperalgesia, bispectral index, BIS

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