Penehyclidine Does Not Reduce Postoperative Nausea and Vomiting in Bariatric Surgery

Penehyclidine does not decrease postoperative nausea and vomiting among patients who underwent laparoscopic bariatric surgery (LBS), according to a study in BMC Anesthesiology.

Researchers hypothesized that intravenous infusion of penehyclidine would alleviate postoperative nausea and vomiting and improve postoperative recovery during the initial 48 hours in patients who had LBS.

All participants were American Society of Anesthesiologists physical status I to III, aged 18 to 60 years, and scheduled for elective LBS under general anesthesia. The same surgeon conducted all procedures, including laparoscopic sleeve gastrectomy, laparoscopic sleeve gastrectomy plus duodenojejunal bypass, laparoscopic sleeve gastrectomy plus jejunojejunal bypass, and 1 anastomosis gastric bypass.

The participants were randomly assigned 1:2 to receive saline (control group) or a single intravenous dose of penehyclidine 0.5 mg (PHC group). The primary outcome was the incidence of postoperative nausea and vomiting within the first 48 hours postoperatively.

A total of 113 patients (mean [SD] age, 34[9] years; men, 22%) were included in the control group, and 221 were in the PHC group (mean age, 33[8] years; men, 31%).

Within the first 48 hours postoperatively, postoperative nausea and vomiting occurred in 159 (48%) patients, including 58 (51%) in the control group and 101 (46%) in the PHC group. No significant difference was observed in the incidence or severity of postoperative nausea and vomiting between the 2 groups (P >.05).

Within the initial 24 postoperative hours, 48% of participants had postoperative nausea and vomiting. Incidence of postoperative nausea and vomiting decreased to 14% in the control group and 11% in the PHC group during the initial 24 to 48 hours postsurgical procedure. The 2 groups had a comparable incidence of postoperative nausea and vomiting in the 2 time periods (P >.05). No significant difference occurred in the incidence or severity of postoperative nausea and vomiting, postoperative nausea, or postoperative vomiting during the first 48 hours after LBS (P >.05).

No significant difference was found regarding the proportion of patients who had postoperative rescue antiemetic therapy or water intake amount between the 2 groups in both postoperative periods (P >.05).

The time to first flatus was significantly greater in the PHC group (median onset, 22 hours) compared with the control group (median onset, 21 hours), according to Kaplan-Meier curves (P = .036).

Study limitations include enrolling only patients who had elective LBS, were aged 18 to 60 years, and had ASA physical status I to III. Also, the single-center study had a relatively small sample size, which limits generalizability of the findings. The researchers noted that their results should be considered with caution, and further research is needed to determine the appropriate dosage of penehyclidine to prevent postoperative nausea and vomiting in patients with obesity.

“Penehyclidine did not decrease PONV [postoperative nausea and vomiting] in patients who underwent LBS,” the study authors noted. “As ‘metabolic surgery’ is increasingly recognized by the public, further well-designed randomized controlled trials are warranted to validate the results and provide high-quality evidence for improving antiemetic treatment for the prevention and management of PONV.”