Effect of Propofol–Fentanyl Compared with Sevoflurane–Fentanyl Anesthesia on the Incidence of Postoperative Nausea and Vomiting after Infratentorial Craniotomies: A Randomized Controlled Trial

Postoperative nausea and vomiting (PONV) is common after craniotomy, and the prevalence is much higher after infratentorial surgeries. Total intravenous anesthesia (TIVA) has been widely reported to reduce PONV compared with inhalation anesthesia (INHA). However, randomized controlled clinical trials on the incidence of PONV following infratentorial craniotomies are inconclusive. This study assessed the effect of TIVA with propofol and fentanyl compared with INHA with sevoflurane and fentanyl on PONV after infratentorial craniotomies. Sixty-two patients were randomized to receive either TIVA or INHA. The primary outcome was the cumulative 24-hour PONV incidence. Secondary outcomes included 48-hour PONV incidence, rescue antiemetic requirements, intraoperative brain relaxation, hemodynamic stability, and emergence times. The cumulative 24-hour PONV incidence was comparable between TIVA and INHA: 64.52 versus 77.42% (relative risk = 0.74; 95% confidence interval, 0.46–1.22; p = 0.263). However, the TIVA group exhibited significantly lower PONV incidences during the early postoperative period at 0, 0.5, 1, and 2 hours (p < 0.05) and required significantly lower doses of norepinephrine to maintain hemodynamic stability (p = 0.009). Subgroup analysis for microvascular decompression of cranial nerves similarly showed no significant difference (p = 0.402). Brain relaxation, blood loss, time to extubation, and antiemetic requirements did not differ between groups. TIVA with propofol and fentanyl for infratentorial craniotomy did not influence cumulative 24-hour PONV incidence, antiemetic requirements, recovery time, brain relaxation, and blood loss compared with the INHA. However, the TIVA group had a lower early 2-hour PONV incidence and was associated with less intraoperative vasopressor requirement.