Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy: Propensity score matching analysis

2016
Remifentaniland nitrous oxide (N2O) are 2 commonly used anesthetic agents. Both these agents are known risk factors for postoperative nauseaand vomiting(PONV). However, remifentaniland N2O have not been directly compared in a published study. Remifentanilcan induce acute tolerance or hyperalgesia, thus affecting postoperative pain. The objective of this retrospective study is to compare the effects of remifentaniland N2O on PONV and pain in patients receiving intravenous patient-controlled analgesia(IV-PCA) after thyroidectomy. We analyzed the electronic medical records of 992 patients receiving fentanyl-based IV-PCA after thyroidectomyat Chung-Ang University Hospital from January 1, 2010 to April 30, 2016. We categorized the patients according to anesthetic agents used: group N2O (n = 745) and group remifentanil(n = 247). The propensity score matchingmethod was used to match patients in the 2 groups based on their covariates. Finally, 128 matched subjects were selected from each group. There were no differences between groups for all covariates after propensity score matching. The numeric rating scale for nausea(0.55 ± 0.88 vs 0.27 ± 0.76, P = 0.01) was higher and complete response (88 [68.8%] vs 106 [82.8%], P = 0.001) was lower in group N2O compared with group remifentanilon postoperative day 0. However, the visual analog scale score for pain (3.47 ± 2.02 vs 3.97 ± 1.48, P = 0.025) was higher in group remifentanilthan group N2O on postoperative day 0. In patients receiving IV-PCA after thyroidectomy, postoperative nauseawas lower but postoperative pain was higher in group remifentanil.
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