Effect of multimodal intervention on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy

J Int Med Res. 2019 May;47(5):2026-2033. doi: 10.1177/0300060519835700. Epub 2019 Mar 18.


Objective: Postoperative nausea and vomiting (PONV) is a common complication in patients undergoing gynecological laparoscopic surgery, and achieving good results is difficult with a single antiemetic method. This study investigated whether multimodal intervention can reduce PONV in patients undergoing gynecological laparoscopic surgery.

Methods: A total of 153 patients who underwent gynecological laparoscopic surgery were randomized into the control group and multimodal group. Patients in the multimodal group received dexmedetomidine 1 µg/kg intravenously 15 minutes before induction of anesthesia. A bilateral transversus abdominis plane block was performed with 0.375% ropivacaine 30 mL after induction of anesthesia. Scores of postoperative nausea and vomiting, the visual analog scale, and the Bruggemann comfort scale (BCS) were assessed 24 hours postoperatively.

Results: Nausea and vomiting scores were significantly lower at 2, 6, and 24 hours in the multimodal group compared with the control group. BCS scores were significantly higher at 0 to 24 hours in the multimodal group compared with the control group.

Conclusions: Multimodal intervention improves PONV and increases patients' comfort. The multimodal approach can also enhance recovery after gynecological laparoscopic surgery.

Keywords: Postoperative nausea and vomiting; anesthesia; gynecological laparoscopy; multimodal intervention; surgery; transversus abdominis plane block.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Female
  • Gynecologic Surgical Procedures / adverse effects*
  • Humans
  • Incidence
  • Laparoscopy / adverse effects*
  • Pain Measurement
  • Postoperative Nausea and Vomiting / epidemiology
  • Postoperative Nausea and Vomiting / etiology*
  • Postoperative Nausea and Vomiting / therapy*