Prevention of penehyclidine on postoperative nausea and vomiting in patients with thyroid surgery: a prospective, randomized, double-blinded comparison

Backgroud: Postoperative nausea and vomiting (PONV) is one of the most common complication after thyroid surgery under general anesthesia. Propofol-based total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing thyroid surgery. Penehyclidine, an anticholinergic agent with an elimination half-life over 10 hours, is widely used as premedication to reduce glandular secretion. This study was to explore the preventative effects of penehyclidine with propofol based TIVA to single-TIVA on PONV in patients undergoing thyroid surgery. Methods: : A total of 100 patients scheduled for thyroid surgery were randomly assigned into penehyclidine group or TIVA group. Propofol was used for TIVA in all patients. There were no patients who received premedication. Patients were administrated with 5ml of normal saline or 0.5mg of penehyclidin soon after anesthesia induction. The incidence of nausea and vomiting, severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 hours in 2 time periods (0-2 h and 2-24 h). Results: : The overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2-24 h after surgery. However, there was no significant difference between the two groups at 0-2 h after surgery. Conclusions: : Penehyclidine with propofol based TIVA was more effective in PONV than TIVA, especially 2-24 h after thyroid surgery. Trial registration: https://www.chictr.org.cn/edit.aspx?pid=132463&htm=4 (Ref: ChiCTR2100050278, the full date of first registration: 25/08/2021).