Effect Of Subhypnotic Dose Of Propofol Combined With Tropisetron On Nausea And Vomiting In Patients With Postoperative Intravenous Analgesia In Gynecology

Background Postoperative nausea and vomiting(PONV)is a common postoperative complication of patients receiving gynecological laparoscopic surgery.The physical discomfort,bleeding,recovery delay and additional costs caused by PONV bring huge disease burden to patients.Early use of preventive drugs can minimize the incidence and severity of PONV,but there is remain a high incidence of PONV in patients receiving gynecological laparoscopic surgery appling patient-controlled intravenous analgesia(PCIA).The Consensus of the Fourth Edition of the Guidelines for the Treatment of Postoperative Nausea and Vomiting suggests that the combination of multiple drugs should be used to prevent PONV in the middle and high-risk groups in clinical practice,and the use of one drug intervention cannot antagonize all or most of the chemoreceptor trigger band receptors.Low risk patients need at least one antiemetic drug,medium risk patients need at least two preventive measures,and high risk patients need at least three antiemetic interventions.At present,the main control measures in China are the use of 5-HT3 receptor antagonists and corticosteroids.Propofol has been used to prevent nausea and vomiting in conscious patients during and after operation under general anesthesia.Under sub-hypnotic dose,it has the advantages of rapid onset,less adverse reactions,high patient satisfaction,and can promote postoperative rehabilitation of patients.This topic innovatively adds propofol into PCIA formula,hoping to decrease the incidence of PONV during patient-controlled analgesia after gynecological Laparoscopic surgery and improve postoperative satisfaction with PCIA.Objective To explore the effect of sub-hypnotic dose of propofol combined with tropisetron on nausea and vomiting during postoperative patient-controlled analgesia in patients undergoing gynecological laparoscopic surgery,in order to provide a more effective prevention measure for PONV.Methods One hundred and thirty patients undergoing elective laparoscopic panhysterectomy plus bilateral adnexectomy under general anesthesia and PCIA were selected and visited preoperatively the day before surgery to inquire about the current and past medical history of the subjects,and informed consent was signed by the patients.The patients were allocated into two groups : 1)control group(group A): PCIA pump was prepared from sufentanil 1.6 μg/kg + butorphanol 5 mg + tropisetron 10 mg + normal saline to 100 m L;2)propofol group(group B): PCIA pump was prepared from sufentanil 1.6 μ g/kg +butorphanol 5 mg + tropisetron 10 mg + propofol 14.4 mg/kg + normal saline to 100 m L.The set parameters of PCIA pump are: first volume 2m L;continuous volume 2m L/h;additional volume 2m L/time;locking time 15 min;limit volume 24 m L.Observe for 10 min after giving the first dose,send the patient to PACU if there is no abnormal reaction,and inform the patient and family of the method of using analgesic pump.1)The degree of nausea and vomiting were assessed at 0 ～ 2h,2 ～ 12 h and 12 ～ 24 h after operation,and the Ramsay sedation score and VAS pain score were recorded at 2h,6h and 24 h after operation.Patients’ satisfaction with PCIA,adverse reactions(respiratory depression)and whether antiemetic rescue drugs were used were recorded at 24 hours after surgery.Results(1)There was no significant difference in age,height,weight,operation time,anesthesia time,intraoperative infusion volume,smoking history and the proportion of motion sickness history between the two groups(P > 0.05);(2)Compared with group C,the degree of nausea at 0 ～ 24 h after operation in group P was significantly lower,and there was significant difference at 2 ～ 12 h and 12 ～ 24h(P < 0.05);(3)There was no significant difference in the degree of nausea at 0 ～ 24 h after operation between the two groups(P >0.05);(4)Compared with group C,the incidence of nausea at 0 ～ 24 h after operation in group P was significantly lower,and there was significant difference at 2 ～ 12 h and 12 ～ 24h(P <0.05);(5)There was no significant difference in the incidence of vomiting at 0 ～ 24 h after operation between the two groups(P > 0.05);(6)There was no significant difference in Ramsay sedation score,resting and motor VAS pain score at 2h,12 h and 24 h after operation between the two groups(P > 0.05);(7)Compared with group C,postoperative satisfaction was significantly higher in group P(P < 0.05);(8)There was no significant difference in the number of postoperative PCIA compressions and adverse reactions between the two groups(P > 0.05).Conclusion 1.Subhypnotic doses of propofol combined with tropisetron can significantly reduce the incidence of nausea and the severity of nausea within 2 to 24 hours after gynecological laparoscopic surgery compared with tropisetron alone.2.Subhypnotic doses of propofol combined with tropisetron are safe and effective for preventing the occurrence of nausea during patient-controlled intravenous analgesia after gynecological surgery.