RECOVERY AFTER PROPOFOL WITH AND WITHOUT INTRAOPERATIVE FENTANYL IN PATIENTS UNDERGOING AMBULATORY GYNECOLOGIC LAPAROSCOPY

This prospective, randomized double-blind study was conducted to exami ne the effect of intraoperative opioid (fentanyl) supplementation on p ostoperative analgesia, emesis, and recovery in ambulatory patients re ceiving propofol-nitrous oxide anesthesia. Eighty patients undergoing ambulatory gynecologic laparoscopy participated. Confounding variables that could influence the incidence of postoperative emesis were contr olled. Patients received either fentanyl 100 mu g (Group I) or ketorol ac 60 mg (Group II) intravenously (IV) at the time of anesthetic induc tion. No further analgesic supplements were given intraoperatively. An esthesia was induced with propofol and maintained with propofol-nitrou s oxide. Atracurium was used for muscle relaxation and reversed with n eostigmine and glycopyrrolate. Postoperative pain during early recover y was treated with IV fentanyl 25-50 mu g (Group I) or IV ketorolac 15 -30 mg (Group II). Subsequent breakthrough pain in both groups was tre ated with IV fentanyl 25 mu g increments as needed (rescue analgesia). Eighty-four percent of patients in Group I required analgesics during early recovery versus 56% of patients in Group II (P <0.05). Maintena nce dose of propofol was significantly lower in Group I (129+/-35 mu g . kg(-1). min(-1)) than in Group II (170+/-63 mu g . kg(-1). min(-1)) . Immediate recovery (emergence) in the two groups was comparable, des pite different propofol requirements. Although the incidence of emetic sequelae in the postanesthesia care unit was not significantly differ ent between the two treatment groups, a significantly larger number of patients in Group I (fentanyl group) had emetic sequelae that require d therapeutic intervention (Group I 29% versus Group II 10%). Patients in Group I also took a significantly longer time to ambulate and meet criteria for home discharge. These results indicate that, in patients undergoing ambulatory gynecologic laparoscopy, the practice of admini stering a small dose of fentanyl at the time of anesthetic induction r educes maintenance propofol requirement, but fails to provide effectiv e postoperative analgesia. Fentanyl administration at anesthetic induc tion increased the need for rescue antiemetics. The relative severity of emetic sequelae could have contributed to delay in ambulation and d ischarge.