Risk Factors for Postoperative Nausea and Vomiting and the Impact of Zero-Opioid General Anesthesia in Laparoscopic Surgery for Benign Ovarian Cysts

Background: Laparoscopic debulking surgery can effectively remove ovarian cysts and alleviate clinical symptoms, yet it is also associated with a high rate of postoperative nausea and vomiting (PONV). This study aimed to identify the risk factors for PONV occurrence in patients undergoing laparoscopic surgery for benign ovarian cyst debulking. Additionally, it examined the impact of zero-opioid general anesthesia on reducing PONV to improve the prognosis of patients. Methods: We retrospectively analyzed 334 patients who underwent laparoscopic ovarian cyst debulking. The patients were divided into treatment groups and control groups depending on the differences in their treatment strategies. Propensity score matching was performed in a 1:1 ratio according to age, race, and body mass index (BMI); the final number of patients in each group was 100. The clinician performed an ultrasound-guided bilateral transversus abdominis plane block in the treatment group, while the control group received fentanyl before surgery at a dose of 4 μg/kg. Differences in the clinical characteristics of patients between the groups were analyzed, and the incidence of PONV was compared. Independent risk factors for PONV occurrence were analyzed using binary logistic regression. Results: The incidence of PONV was lower in the treatment group (18%) than in the control group (47%). The use of opioid anesthetics (odds ratio (OR) = 4.258, p = 0.028), the anesthesia duration (OR = 1.098, p = 0.025), history of motion sickness (OR = 4.305, p = 0.015), history of PONV (OR = 5.314, p = 0.009), postoperative analgesic pump use (OR = 6.688, p = 0.001), preoperative fluid volume (OR = 0.967, p = 0.000), preoperative use of 5-hydroxytryptamine (OR = 0.982, p = 0.016), and postoperative use of 5-hydroxytryptamine for 12 h (OR = 1.008, p = 0.015) were independent predictive factors for PONV occurrence (p < 0.05). Conclusion: The occurrence of PONV in patients with ovarian cysts is associated with a history of PONV and a history of motion sickness. Implementing a zero-opioid general anesthesia technique can significantly reduce PONV incidence, contributing to improved patient prognoses.