Opioid administration via epidural catheter is a risk factor for postoperative nausea and vomiting in total hip arthroplasty: A retrospective study

Abstract

Background: Postoperative nausea and vomiting (PONV) may lead to extended hospital stay due to severe discomfort and restriction of patient activity. We retrospectively studied PONV incidence following total hip arthroplasty (THA) to evaluate the effect of opioid administration via epidural catheter.

Methods: Our study included 155 affected joints in 136 patients who underwent a first THA from 2011 to 2016. For postoperative analgesia, an epidural catheter was preoperatively placed and used for continuous analgesic delivery into the epidural space up to 2 days after surgery. We analyzed patient age, sex, body mass index (BMI), opioid use via epidural catheter, amount of opioid used intraoperatively, amount of opioid used immediately before the end of the operation, anesthesia duration, and amount of opioid used postoperatively.

Results: PONV was reported for 51 affected joints. Opioid was infused via epidural catheter in 114 affected joints, but not in 41 affected joints. Logistic regression analysis for PONV occurrence revealed a significant difference according to sex (P < 0.05), BMI (P < 0.01), and opioid use via epidural catheter (P < 0.05). Correlation analysis evaluating the occurrence of PONV and BMI using the χ² test demonstrated a significantly higher incidence of PONV in the subgroup of patients with a BMI ≤20 kg/m² (P < 0.01).

Conclusions: These results indicate that without using opioid or other action should be considered when epidural catheter is used in female patients with a BMI ≤20 kg/m².