The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis

Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).

This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.

We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.

Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%] vs. 45[10.4%], P = 0.002) and POD1 (60[19.0%] vs. 59[13.6%], P = 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49 vs. 3.13 ± 1.53, P = 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75 vs. 0.21 ± 0.62, P = 0.027) and rescue anti-emetics (27 [17.2%] vs. 15 [9.6%], P = 0.047) on POD 0 were both lower in the group P.

In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.