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BJA Advance Access published online on June 7, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem146
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Epidural naloxone reduces postoperative nausea and vomiting in patients receiving epidural sufentanil for postoperative analgesia

M. K. Kim1, S. B. Nam2,3, M. J. Cho2 and Y.-S. Shin2,3,*

1 Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
2 Department of Anaesthesiology and Pain Medicine
3 Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Republic of Korea

* Corresponding author: Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul 120-752, Republic of Korea. E-mail: ysshin{at}yumc.yonsei.ac.kr

Background: Epidural opioids have excellent analgesic properties, but their side-effects limit their use in patient-controlled epidural analgesia. This study was designed to evaluate the effect of epidural naloxone on the side-effects of sufentanil, focusing on postoperative nausea and vomiting (PONV) in patients undergoing total knee replacement (TKR).

Methods: After obtaining Institutional Review Board approval and informed consent, 50 patients undergoing unilateral TKR were randomly assigned to receive either sufentanil in ropivacaine alone (Group C, n = 25) or the same solution with naloxone (Group N, n = 25) for their postoperative epidural analgesia. Episodes of PONV and five-point-scaled nausea scores were evaluated at 6, 12, and 24 h after epidural analgesia was started. Visual analogue scale (VAS) score for pain and the incidence of sedation, pruritus, hypotension, and respiratory depression were also evaluated at each of three time points.

Results: The nausea score in Group N was significantly lower than that in Group C. The VAS pain score at rest and on movement were significantly lower in Group N than in Group C at 24 h. Other opioid-induced side-effects were not significantly different.

Conclusions: Epidural naloxone was effective in reducing PONV induced by epidural sufentanil and additionally enhanced the analgesic effect. Therefore, concomitant infusion of a small dose of epidural naloxone should be considered to reduce PONV, especially in patients at greater risk for PONV.

Keywords: analgesic techniques, extradural; analgesics opioid, sufentanil; antagonists opioid, naloxone; PONV


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