Flurbiprofen use in patient-controlled intravenous analgesia and the risk of postoperative nausea and vomiting after gynecological laparoscopic surgery: a retrospective case-control study

Objective: To determine whether flurbiprofen-containing patient-controlled intravenous analgesia (PCIA) was associated with an increased risk of postoperative nausea and vomiting (PONV) following gynecological laparoscopic surgery. Design: Retrospective single-center case-control study. Setting: Tertiary care hospital in Guangzhou, China. Population: 2430 patients who underwent gynecological laparoscopic surgery from April 1, 2021 to May 11, 2022. Methods: : Perioperative data were extracted from electronic medical records. Multivariable logistic regression was used to identify independent risk factors for PONV, supported by propensity score matching (PSM) and subgroup analyses. A directed acyclic graph (DAG) was constructed to guide confounder selection. Main outcome measures: The incidence of PONV within 48 hours after surgery. Results: : PONV occurred in 27.7% (554/2000) of patients receiving flurbiprofen-containing PCIA, compared to 23.0% (99/430) without flurbiprofen (absolute risk difference: 4.7%; number needed to harm [NNH] = 21). In multivariable analysis, flurbiprofen use was independently associated with increased PONV risk (adjusted odds ratio [OR] = 1.414, 95% confidence interval [CI] = 1.042–1.918, p = 0.026). Subgroup analysis suggested this association was stronger in older patients and those receiving hydromorphone-based PCIA. Conclusion: Flurbiprofen-containing PCIA is associated with a modest but clinically significant increase in PONV risk after gynecologic laparoscopic surgery. Although it may reduce opioid consumption and shorten hospital stay, clinicians should consider alternative regimens or enhanced antiemetic prophylaxis in high-risk patients.