Jie Chen,1,* Guangxi Piao,1,* Guohui Luan,2 Yunming Yu,3 Wei Zheng,4 Yue Li,5 Chao Zhang,6 Yunzhen Duan,7 Min Zhao,8 Yong Zhang,9 Wei Xiang,10 Lu Cheng,11 Chengcheng Ji,12 Guangyou Duan,1 He Huang1 

1Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Anesthesiology, Qijiang District People’s Hospital, Chongqing, People’s Republic of China; 3Department of Anesthesiology, Three Gorges Hospital of Chongqing University, Chongqing, People’s Republic of China; 4Department of Anesthesiology, People’s Hospital of Yunyang County, Chongqing, People’s Republic of China; 5Department of Anesthesiology, Qianjiang Central Hospital of Chongqing, Chongqing, People’s Republic of China; 6Department of Anesthesiology, People’s Hospital of Shapingba District, Chongqing, People’s Republic of China; 7Department of Anesthesiology, People’s Hospital of Chongqing Hechuan, Chongqing, People’s Republic of China; 8Department of Anesthesiology, People’s Hospital of Wulong District, Chongqing, People’s Republic of China; 9Department of Anesthesiology, People’s Hospital of Jiulongpo District, Chongqing, People’s Republic of China; 10Department of Anesthesiology, People’s Hospital of High-Tech Zone District, Chongqing, People’s Republic of China; 11Department of Anesthesiology, People’s Hospital of Xiushan County, Chongqing, People’s Republic of China; 12Department of Anesthesiology, Chongqing Jiangbei Hospital of Traditional Chinese Medicine, Chongqing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Guangyou Duan; He Huang, The Second Affiliated Hospital, Chongqing Medical University, No. 74, Linjiang Road, Yuzhong District, Chongqing, People’s Republic of China, Tel +86-18323376014 ; +86-13708385559, Email duangy@hospital.cqmu.edu.cn; huanghe@cqmu.edu.cn

Background: Effective methods for the prevention of postoperative nausea and vomiting remain to be found. Building upon previous evidence, we examined whether glycopyrrolate bromide had a preventive effect on nausea and vomiting when used as an adjuvant treatment.
Methods: In 11 participating hospitals, patients who were scheduled to receive gynecological (n=123), gastrointestinal (n=201), thyroid (n=93), and breast surgery (n=51) under general anesthesia and received postoperative opioids were randomly allocated to receive 4 mg dexamethasone and 4 mg tropisetron (Group C) or 4 mg dexamethasone and 4 mg tropisetron combined with 0.2 mg glycopyrrolate bromide (Group G). The primary outcome of postoperative nausea and vomiting was assessed. The secondary outcomes included the incidences of significant nausea and vomiting (defined based on a rating scale of intensity ≥ 4), vomiting, and extra intervention.
Results: In total, 471 patients (234 in Group G and 237 in Group C) were included in the final analysis. The incidence of postoperative nausea and vomiting in Group G was lower than that in Group C (27.8% vs 43.0%, odds rate=0.65, 95% confidence interval =0.50– 0.83, P=0.001). Furthermore, the incidences of significant nausea and vomiting (14.1% vs 27.8%, odds rate=0.50, 95% confidence interval=0.35– 0.74, P< 0.001), vomiting (7.3% vs 15.6%, OR=0.46, 95% confidence interval=0.27– 0.80, P=0.004) and extra intervention (9.4% vs 17.7%, odds rate=0.53, 95% confidence interval=0.33– 0.86, P=0.008) in Group G were all significantly lower than those in Group C. The two groups showed no significant difference in adverse events.
Conclusion: The intravenous administration of 0.2 mg glycopyrronium bromide at the end of surgery can be an effective adjuvant treatment strategy for prevention of nausea and vomiting in patients undergoing surgery under general anesthesia and receiving postoperative opioids.
Trial Registration: The Hospital Ethics Committee of the Second Affiliated Hospital, Chongqing Medical University (Approval ID: 2022– 14-1) approved this study. This trial was registered with Identifier NCT05331651 on ClinicalTrials.gov.

Keywords: glycopyrronium bromide, nausea, vomit, general anesthesia. postoperative opioids