The Effect Of Multi-model Intervention On Postoperative Nausea And Vomiting In Patients Undergoing Gynecological Laparoscopy

Object: This study use the combination of dexmedetomidine and ondansetron united with transversus abdominal plane block,to investigate the efficacy of Multi-model Intervention Project(MIP)on postoperative nausea and vomiting(PONV)in patients undergoing gynecologic laparoscopic surgery.Method: 160 patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups(n=80),controlled group(group C)and multi-model group(group M).Exclusion criteria were nausea or vomiting 24 h before surgery,take psychotropic drugs,drug or alcoholic abused,refused to receive Transversus abdominis plane block,history of heart or respiratory disease,talking disability,uncontrolled high blood pressure,allergy to the study drug.Peripheral venous access was obtained after the patient entered the operation room.Standard monitoring included electrocardiography,heart rate,pulse oximetry,noninvasive blood pressure,and capnography(PETCO2).Lactated Ringer's solution and hydroxyethyl starch were infused by 2:1,infusion volume based on standard 4?2?1.Clean the patient's forehead skin,then the Narcotrend was used to monitor the patient's Narcotrend index(NTI).Patients in group C recieved normal saline 10 ml i.v.15 min before the induction of anesthesia.Induction of anesthesia : General anesthesia was induced with midazolam 0.08 mg/kg,fentanyl 4 ?g/kg,propofol 2 mg/kg and rocuronium 0.6 mg/kg.laryngeal mask airway(LMA)was inserted when loss of eyelash reflex was confirmed.Set the mechanical ventilation.Patients in group M recieved dexmedetomidine 1?g· kg-1 i.v.15 min before the induction of anesthesia,and bilateral transverse abdominal plan(TAP)block was performed with 0.375% ropivacaine 30 ml after the induction of anesthesia.Anesthesia was maintained with remifentanil using micro pump at a speed of 0.15 ug/(kg·min).The propofol pumping rate adjusted by observing Narcotrend,so that NTI value maintained at 37 to 46,intraoperative BP and HR fluctuation should in the base value of 20%.All the patients in two groups received Flurbiprofen Axetil 100 mg and ondansetron 8mg before the end of surgery.Patients who had agreed to have PCA would received postoperative i.v.patient-controlled analgesia(PCA).PCA combined sufentanil 100?g with normal saline to 100 ml.After recovery safely in postanesthesia care unit,send patient back ward.Record the amount of propofol,duration of awakening,time of removal of laryngeal mask.The VAS score,severity of postoperative nausea and vomiting,BCS comfort score were assessed for 24 h postoperative,.Patients with VAS more than 3 points were treated with flubiprofen axetil 50 mg,the frequency of added analgesics were also recorded.Results: Compared with group C,nausea and vomiting score significantly decreased at 6h?12h?24h(P?0.05 or P?0.01)in group M.Compared with group C,VAS score decreased in group M but with no significance;BCS comfort score significantly increased at 0~24h(P?0.05 or 0.01).Compared with 4 person(5.1%)in group M,13 person(17.3%)had analgesic postoperative in group C,the difference had significance.Conclusion: Multi-model Intervention Project(MIP)can provide siginificant improvement in postoperative nausea and vomiting(PONV).Multi-model Intervention Project(MIP)could relieve postoperative complication,raise patient's comfort level,enhanced satisfaction on anesthesia.