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

In-Suk Lee; Yun-Mi Kim

doi:10.4069/kjwhn.2015.21.1.1

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

Original Article

Korean Journal of Women Health Nursing 2015; 21(1): 1-10.

Published online: 27 March 2015

DOI: https://doi.org/10.4069/kjwhn.2015.21.1.1

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

In-Suk Lee¹, Yun-Mi Kim²

¹The Catholic University of Korea, Yeuido St. Mary's Hospital, Seoul, Korea.

²College of Nursing, Gachon University, Incheon, Korea.

Corresponding author: Kim, Yun-Mi. College of Nursing, Gachon University, 191 Hambakmoe-ro, Yeunsoo-dong, Yeunsoo-gu, Incheon 406-799, Korea. Tel: +82-32-820-4202, Fax: +82-32-820-4201, ymkim@gachon.ac.kr

Received 19 November 2014 Revised 28 January 2015 Accepted 13 March 2015

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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

Keywords: Postoperative pain, Postoperative nausea and vomiting, Remifentanil, Gynecologic surgery, Laparoscopic surgery

Figures and Tables

Table 1

Research Design

Groups	Pretest	Treatment anesthesia	Posttest
	Pretest	Treatment anesthesia	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)
Variables	Categories	n(%) or M±SD	n(%) or M±SD	x² or t (p)
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)
Marital status	Unmarried	6 (24.0)	9 (45.0)	2.21 (.138)
Education	Less than HS	4 (8.8)	1 (2.2)	(.362^†)
Education	More than MS	21 (46.6)	19 (42.2)	(.362^†)
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
Time	M±SD	M±SD	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
	M±SD	M±SD	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
Time	M±SD	M±SD	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/Administration of additional antiemetics	M±SD	M±SD	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.

Notes

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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