Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia

Summary Objective This study aims to evaluate retrospectively the electronic medical records of surgical patients who received intravenous patient-controlled analgesia, to identify potential relationships between the incidence and risk factorsof postoperative nauseaand vomiting(PONV). Methods Records of 6773 adult patients who received fentanyl-based intravenous patient-controlled analgesiaafter surgery at Chung-Ang University Hospital between January 1, 2010 and December 31, 2015 were reviewed. Multiple logistic regressions were used to identify risk factorsfor PONV. Results Of 6773 patients, 1216 (18.0%) were recorded to have PONV. In multiple logistic regression analysis, female gender, nonsmoking status, history of motion sicknessor PONV, use of desfluraneand nitrous oxide, and preintubation use of opioid analgesia were independent risk factorsfor PONV. Conclusions Despite the use of antiemeticprophylaxis, 18.0% of patients with intravenous patient-controlled analgesiahad PONV. Use of desfluraneand nitrous oxide, in addition to risk factorsincluded in the Apfel score (female gender, nonsmoking status, history of PONV or motion sickness, and use of postoperative opioids) were identified as independent risk factors. As the incidence of PONV was 2.8%, 6.0%, 11.7%, 15.2%, 21.1%, 50.0%, and 100% for patients who had 0, 1, 2, 3, 4, 5, and all these risk factors, respectively, risk-adapted, multimodal, or combination therapy should be applied for patients receiving general anesthesia.