Journal List > Korean J Women Health Nurs > v.21(1) > 1089498

Lee and Kim: Comparison of Postoperative Pain and Nausea and Vomiting between Desflurane and Desflurane-remifentanil Anesthesia for Gynecologic Laparoscopic Surgery



The purpose of this study was to compare desflurane anesthesia with desflurane-remifentanil anesthesia by measuring postoperative pain, nausea and vomiting after gynecologic laparoscopic surgery.


Data were collected using a random double blind method. The experimental group treated with desflurane-remifentanil anesthesia had a total of 25 patients. The control group had 20 patients who were treated with desflurane anesthesia. Pain (VAS), pushing PCA button, nausea and vomiting (VAS) were assessed at PACU (Post Anesthesia Care Unit) arrival, 10 min, 20 min, 30 min in PACU and 2 hrs, 6 hrs, 24 hrs, 48 hrs in ward. INVR was assessed at 24 hrs. Extra analgesics and extra antiemetics were measured in PACU and the ward. Data were analyzed using t-test and repeated measure using ANOVA.


The experimental group presented with more postoperative pain (F=7.55, p<.001) than the control group. The experimental group took more extra analgesics in PACU and pressed the PCA button more often for 6 hours. The experimental group complained more postoperative nausea (F=2.11, p=.043) than the control group and took extra antiemetics during postoperative period of 24 hours.


We conclude that desflurane-remifentanil anesthesia needs better management than desflurane anesthesia due to increased pain, nausea & vomiting after gynecologic laparoscopic surgery.

Figures and Tables

Table 1

Research Design

Groups Pretest Treatment anesthesia Posttest
Assess in PACU Assess in ward
Pre-op day During op PACU a 10 min 20 min 30 min 2 hrs 6 hrs 24 hrs 48 hrs
Exp. E1 Remifentanil with desflurane E2 E3 E4 E5 E6 E7 E8 E9
Cont. C1 Desflurane C2 C3 C4 C5 C6 C7 C8 C9

Exp.=experimental group, Cont.=control group; E1,C1=Pretests of get research permission, History taking of nausea (VAS), Assess pain (VAS); PACU a=Post Anesthesia Care Unit arrival; E2,E3,E4,C2,C3,C4=Posttests of assess pain (VAS), Nausea (VAS); E5,E6,E7,E8,E9,C5,C6,C7,C8,C9=Posttests of assess pain (VAS), Nausea (VAS), Frequency of pushing; PCA (Patient Controlled Anesthesia) button; E5,C5=Total Counts of additional drugs (analgesics and antiemetics) in PACU; E8,C8=assess Index of Nausea, Vomiting & Retching (INVR); E9,C9=Total Counts of additional drugs (analgesics and antiemetics) in Ward.

Table 2

Homogeneity Test for General Characteristics, Preoperative Pain and Nausea between Experimental and Control Group (N=45)

Variables Categories Exp. (n=25) Cont. (n=25) x2 or t (p)
n(%) or M±SD n(%) or M±SD
Age(year) 40.24±12.83 34.40±9.58 1.747 (.088)
Height(cm) 159.18±5.52 161.75±7.12 -1.364 (.180)
Body weight(kg) 59.64±8.69 58.57±12.55 0.339 (.736)
Hospitalization period(day) 6.00±1.44 5.95±1.64 0.109 (.914)
Marital status Married 19 (76.0) 11 (55.0) 2.21 (.138)
Unmarried 6 (24.0) 9 (45.0)
Education Less than HS 4 (8.8) 1 (2.2) (.362)
More than MS 21 (46.6) 19 (42.2)
Religion Catholic 8 (32.0) 7 (35.0) 0.52 (.772)
Protestant 7 (28.0) 7 (35.0)
None 10 (40.0) 6 (30.0)
Pain (Pre-op) 0.16±0.55 0.00±0.00 1.45 (.161)
Nausea (Pre-op) 0.00±0.00 0.00±0.00 - (-)

Fisher's exact test; Exp.=experimental group; Cont.=control group; HS=high school; MS=middle school; Pre-op=preoperative.

Table 3

Comparison of Postoperative Pain between Experimental and Control Group (N=45)

Time Exp. (n=25) Cont. (n=20) t p Source F p
PACU arrival 5.84±2.23 2.80±2.14 4.62 <.001 Group 34.08 <.001
10 min 5.96±1.70 3.15±1.90 5.24 <.001 Time 63.20 <.001
20 min 4.68±0.95 3.35±1.09 4.38 <.001 Group*Time 7.55 <.001
30 min 4.08±0.81 2.80±0.89 5.02 <.001
2 hr 3.92±1.35 2.75±1.12 3.11 .003
6 hr 2.48±0.92 1.90±1.12 1.91 .063
24 hr 0.96±0.89 0.65±0.67 1.29 .203
48 hr 0.20±0.41 0.20±0.41 0.00 1.000

PACU=post anesthesia care unit, Exp.=experimental group, Cont.=control group,

Table 4

Comparison of Frequency of Pushing PCA Button and Administration of Extra Analgesics between Experimental and Control Group (N=45)

Exp. (n=25) Cont. (n=20) t p Source F p
Frequency of pushing PCA button
 0~30 minutes 5.52±1.71 5.10±1.92 0.78 .442 Group 14.09 <.001
 30 min~2 hr 6.00±1.80 3.90±1.89 3.80 <.001 Time 62.72 <.001
 3 hr~6 hr 3.12±1.96 1.60±1.19 3.21 .003 Group*Time 7.52 .001
 6 hr~24 hr 0.96±0.94 0.50±0.89 1.68 .101
 24 hr~48 hr 0.36±0.70 0.20±0.70 0.76 .449
Frequency of extra analgesics in PACU 1.16±0.94 0.40±0.75 2.93 .005
Frequency of extra analgesics in ward 0.08±0.28 0.00±0.00 1.45 .161

PCA=patient controlled anesthesia, PACU=post anesthesia care unit.

Table 5

Comparison of Nausea between Experimental and Control Group (N=45)

Time Exp. (n=25) Con. (n=20) t p Source F p
PACU arrival 0.60±2.08 0.00±0.00 1.44 .162 Group 6.50 .014
10 min 0.60±2.08 0.00±0.00 1.44 .162 Time 3.17 .003
20 min 0.52±1.76 0.00±0.00 1.48 .152 Group*Time 2.11 .043
30 min 0.52±1.58 0.00±0.00 1.64 .114
2 hr 1.00±1.15 0.25±0.64 2.60 .013
6 hr 0.28±0.61 0.15±0.49 0.77 .445
24 hr 0.08±0.28 0.00±0.00 1.45 .161
48 hr 0.00±0.00 0.00±0.00 - -

PACU=post anesthesia care unit.

Table 6

Comparison of INVR and Administration of Extra Antiemetics between Experimental and Control Group (N=45)

INVR/Administration of additional antiemetics Exp. (n=25) Con. (n=20) t p
INVR, post 24 hr 10.44±3.54 8.20±0.52 3.13 .004
Frequency of extra antiemetics in PACU 0.24±0.44 0.00±0.00 2.75 .011
Frequency of extra antiemetics in ward 3.72±1.72 2.10±0.79 4.19 <.001

INVR=index of nausea, vomiting and retching; PACU=post anesthesia care unit.


This article is based on a part of the first author's master's thesis from Gachon University.

Summary Statement

▪ What is already known about this topic?
Remifentanil combined with inhalation anesthetics such as sevoflurane might cause pain and nausea after surgery however, this is still being debated. Studies conducted using desflurane-remifentanil combination anesthetics were not found in the literature review.
▪ What this paper adds?
The experimental group presented with more postoperative pain than the control group. The experimental group took more extra analgesics in PACU and pressed the PCA button more often for 6 hours. The experimental group complained more postoperative nausea than the control group and took extra antiemetics during postoperative period of 24 hours.
▪ Implications for practice, education and/or policy
Desflurane-remifentanil anesthesia requires more careful nursing intervention in post-operative pain management until 6 hours and post operative nausea management until 24 hours.


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