Comparison of Postoperative Pain and Incidence of Postoperative Nausea and Vomiting with Intravenous Patient-controlled Analgesia Using High- and Low-dose Fentanyl after Total Laparoscopic Hysterectomy

Abstract

The dose of intravenous patient-controlled analgesia（IVPCA）using fentanyl was retrospectively evaluated in 50 patients who underwent total laparoscopic hysterectomy（TLH）. Patients were divided into two groups（high- and low-dose group）according to the median dose of fentanyl administered. The background infusion rate of fentanyl was lower in the low-dose compared to the high-dose group（0.27±0.05 µg/kg/h vs. 0.37±0.04 µg/kg/h, p<0.01）, and fentanyl consumption was significantly less in the low-dose group during the first 24 hours postoperatively. The incidence of postoperative nausea and vomiting（PONV）was less in the low-dose compared to high-dose group（12% vs. 40%, p=0.02）. However, there was no significant difference in the requirement for bolus PCA or rescue analgesics；pain scores, assessed using the numerical pain rating scale, were also similar. In patients undergoing TLH with IVPCA, a background infusion rate of fentanyl 0.27 µg/kg/h was sufficient to provide effective analgesia, with decreased incidence of PONV.