Yang X-Y, Xiao J, Chen Y-H, Wang Z-T, Wang H-L, He D-H, Zhang J
Department of Anaesthesiology, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Anaesthesiology, Huashan Hospital North, Fudan University, Shanghai 201907, China.
Br J Anaesth. 2015 Dec;115(6):883-9. doi: 10.1093/bja/aev352. Epub 2015 Oct 27.
Postoperative nausea and vomiting (PONV) is commonly reported after surgery and anaesthesia. We compared the effects of combinations of electrical acupoint stimulation or tropisetron with dexamethasone with the effects of dexamethasone alone, for inhibition of PONV in gynaecological patients undergoing laparoscopic surgery.
We randomized 157 patients undergoing elective gynaecological laparoscopic surgery under general anaesthesia into the following three groups: acupoint stimulation+dexamethasone (Group Acu, n=53), tropisetron+dexamethasone (Group Trp, n=53), and dexamethasone alone (Group Dxm, n=51). The incidence of nausea, vomiting, and need for rescue antiemetics was recorded 2, 6, 24, and 48 h after surgery.
We found significant differences in the incidence of PONV during 24 h after surgery between the combination therapy groups and the dexamethasone-alone group (P=0.021). In the first 24 h, 28% of patients in Group Acu, 26% of patients in Group Trp, and 50% of patients in Group Dxm experienced nausea, vomiting, or both. The incidence of 24 h PONV in Group Acu was significantly lower than that in Group Dxm (P=0.048; odds ratio 0.389; 95% CI 0.170-0.891). The incidence of 24 h PONV in Group Trp was also significantly lower than that in Group Dxm (P=0.042; odds ratio 0.359; 95% CI 0.157-0.819). There was no significant difference between Group Acu and Group Trp (P=0.857). The need for antiemetic rescue medication was similar in the three groups. All groups expressed similar patient satisfaction.
Combined with dexamethasone, electrical acupoint stimulation or tropisetron is more effective in PONV prophylaxis than dexamethasone alone in gynaecological patients undergoing laparoscopic surgery.
NCT 02096835.
术后恶心呕吐（PONV）是手术和麻醉后常见的情况。我们比较了电穴位刺激或托烷司琼与地塞米松联合使用，与单独使用地塞米松对接受腹腔镜手术的妇科患者抑制PONV的效果。
我们将157例在全身麻醉下接受择期妇科腹腔镜手术的患者随机分为以下三组：穴位刺激+地塞米松组（穴位组，n = 53）、托烷司琼+地塞米松组（托烷司琼组，n = 53）和单独使用地塞米松组（地塞米松组，n = 51）。记录术后2、6、24和48小时恶心、呕吐的发生率以及使用急救止吐药的情况。
我们发现联合治疗组与单独使用地塞米松组在术后24小时内的PONV发生率存在显著差异（P = 0.021）。在术后的前24小时内，穴位组28%的患者、托烷司琼组26%的患者以及地塞米松组50%的患者出现恶心、呕吐或两者皆有。穴位组24小时PONV的发生率显著低于地塞米松组（P = 0.048；比值比0.389；95%可信区间0.170 - 0.891）。托烷司琼组24小时PONV的发生率也显著低于地塞米松组（P = 0.042；比值比0.359；95%可信区间0.157 - 0.819）。穴位组和托烷司琼组之间无显著差异（P = 0.857）。三组使用急救止吐药的需求相似。所有组患者的满意度相似。
对于接受腹腔镜手术的妇科患者，电穴位刺激或托烷司琼与地塞米松联合使用在预防PONV方面比单独使用地塞米松更有效。
NCT 02096835。
