Postoperative nausea and vomiting in paediatric ambulatory surgery:: sevoflurane versus spinal anaesthesia with propofol sedation

Background: Descriptive data report a very low rate of postoperative nausea and vomiting (PONV) following spinal anaesthesia in children. In an attempt to corroborate this observation, we designed a prospective randomized study to compare spinal anaesthesia with intravenous propofol sedation (SA) (n = 21) to inhalational sevoflurane anaesthesia (IA) (n = 19) with regard to PONV and postoperative analgesia in children (aged 3-12 years) undergoing ambulatory inguinal surgery. Results: No difference was found concerning the number of patients experiencing PONV in each group (SA 1/21 versus IA 5/19; P = 0.085). However, spinal anaesthesia was associated with a reduced number of PONV episodes (1/21) compared with inhalation anaesthesia (8/19) (P = 0.014) and the need for supplemental postoperative analgesia with ketoralac was significantly lower in the SA group (3/21) compared to the IA group (14/19) (P < 0.001). Despite these benefits of spinal anaesthesia compared with inhalational anaesthesia, spinal anaesthesia did not decrease the time to discharge from the ambulatory surgery unit [SA 161 (SD 51) min, VI 164 (SD 41) min; P = NS] and the overall PONV experience was rated as 'no problem' by all patients, except one, regardless of anaesthetic protocol used. Conclusions: Despite the reduced number of emetic episodes and the Setter immediate postoperative analgesia associated with spinal anaesthesia, no difference could be identified between the two different anaesthetic protocols regarding time to discharge or overall patient satisfaction. Thus, despite minor advantages associated with spinal anaesthesis with propofol sedation, both anaesthetic regimen appear equally suitable for use in the paediatric outpatient setting.