Comparison of Propofol and Sevoflurane as Anesthesia Maintenance Agents in Relation to Postoperative Pain, Nausea and Vomiting During Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Single-Center, Randomized, Single-Blind Pilot Study

Introduction Halogen gas anesthesia is considered to be more conducive to postoperative nausea and vomiting (PONV) than total intravenous anesthesia. This difference has been demonstrated in surgery, but there have been no studies on postoperative pain (POP), nausea and vomiting based on anesthesia in the specific environment of endoscopy, to the best of our knowledge. Our aim was therefore to carry out a preliminary study to investigate a trend in POP, nausea and vomiting during endoscopic retrograde cholangio-pancreatography (ERCP), depending on the type of the maintenance anesthetic agent used. Methods This single-center, prospective, randomized, single-blind pilot study included 42 adult patients (American Society of Anesthesiologists classification score, ASA ≤ 3) benefiting from ERCP. They were randomized into two groups depending on the type of maintenance anesthetic used: the "sevoflurane" group and the "propofol" group (target-controlled infusion, Schnider model). Moreover, in both groups, all patients received balanced anesthesia based on alfentanil and rocuronium. The principal aim of our study was to investigate pain, nausea and vomiting during the first 48 hours postoperatively based on the anesthesia maintenance agent chosen. During the first 48 hours, PONV episodes were counted, pain was measured using the visual analogue scale and all analgesics and antiemetics administered were recorded. Results The two groups studied showed no statistically significant difference. The incidence of PONV was 36.4% in the sevoflurane group and 30% in the propofol group. Statistical analysis showed no significant difference in the occurrence of PONV or in the number of emetic episodes at 48 h postoperatively. There was no significant difference between the two groups in terms of the analgesics used to assess postoperative pain. Finally, there were no differences in the types of analgesics used postoperatively. Conclusion There appeared to be no difference in terms of postoperative pain, nausea and vomiting after ERCP in adults, based on the choice of maintenance anesthetic agent (sevoflurane versus propofol). However, the results of this pilot study should be confirmed in a larger sample.