REVERSAL OF NEUROMUSCULAR BLOCKADE WITH NEOSTIGMINE HAS NO EFFECT ON THE INCIDENCE OR SEVERITY OF POSTOPERATIVE NAUSEA AND VOMITING

We performed this randomized, double-blind, placebo-controlled study t o determine whether reversal of neuromuscular block with neostigmine i ncreases the incidence and severity of postoperative nausea and vomiti ng (PONV). We studied 162 women undergoing abdominal hysterectomy and randomly allocated them into two groups. In Group A, neuromuscular blo ck produced with mivacurium was antagonized with neostigmine 2.0 mg an d glycopyrrolate 0.4 mg intravenously, whereas Group B received no dru gs to facilitate antagonism of blockade. The incidence and severity of PONV was assessed up to 27 h after the operation. There was no differ ence in PONV between the groups (in Group A 35% had nausea and 33% vom ited; in Group B 28% nauseated and 40% vomited) or in the amount of an tiemetics given. We had a 75% chance to find a 30% difference in PONV. We conclude that the administration of neostigmine and glycopyrrolate at the end of anesthesia to reverse neuromuscular block does not incr ease the incidence or severity of PONV. Implications: Neostigmine may increase postoperative nausea and vomiting. In this study, omission of reversal of neuromuscular block with neostigmine failed to decrease t he incidence or severity of postoperative nausea and vomiting.