Background: Opioids can produce postoperative nausea and vomiting (PONV). Remifentanil is a nonaccumulative ultra short-acting opioid because of its rapid systemic elimination. This rapid systemic elimination could contribute to a faster weaning from the opioid side-effects like PONV. This study compared remifentanil and fentanyl with regards to the frequency of PONV in laparoscopic cholecystectomy with using propofol.

METHODS: Sixty ASA physical status I or II patients who were scheduled for laparoscopic cholecystectomy were randomly assigned to either the remifentanil group (n = 30) or the fentanyl group (n = 30). Anesthesia was induced with propofol, rocuronium and remifentanil (n = 30, 1µ/kg) or fentanyl (n = 30, 2µ/kg). After tracheal intubation, anesthesia was maintained with propofol, oxygen/air and infusion of opioid (only for remifentanil group 0.2-0.5µ/kg/min). Postoperatively (1 hr, 12 hr, and 24 hr), we recorded the visual analogue scale (VAS), the rescue meperidine consumption, the number of patients with episodes of PONV and the number of ondansetron injection.

RESULTS: The number of PONV episodes were significantly higher in the fentanyl group at the 1-12 hr postoperative period (p < 0.05; n = 8 vs. n = 1, fentanyl and remifentanil, respectively). However, the incidence of PONV at 0-1 hr and 12-24 hr and the total incidence of PONV were not different between the two groups.

CONCLUSIONS: The use of ultra-short acting remifentanil instead of fentanyl can reduce PONV at 1-12 postoperative hours in the laparoscopic cholecystectomy patients.