Data collection
nausea, postoperative pain, blood loss, Postoperative pain, postoperative nausea and vomiting, pain, PONV, NRS
BLOOD LOSS
Data collection was performed by investigators who were blinded to group allocation and were not involved in the anesthesia of patients. The clinical characteristics (sex, age, height, weight, and smoking status) of the patients were recorded, and data on the type of surgery, duration of anesthesia, duration of surgery, intraoperative remifentanil, intraoperative fluids, and blood loss were collected. The primary outcome was the overall incidence of postoperative nausea and vomiting during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery. The intensity of nausea was rated on an 11-point verbal rating scale (VRS). A score of 0 was defined as no nausea, and 10 as severe nausea. The severity of nausea was classified according to the VRS score as follows: no nausea (0), mild (1–3), moderate (4–6), and severe (7–10). Patients who vomited were also included as having severe nausea if the VRS score was 7 or higher. PONV scores were recorded on arrival at the PACU and at 1 h, 6 h, and 24 h postoperatively. All episodes of PONV during the 24 h after surgery were recorded. The rescue antiemetic was ramosetron 0.3 mg. Rescue antiemetics were administered when the patient experienced nausea and requested treatment, when the patient had vomited, or when the VRS score for nausea was ≥ 4. Postoperative pain was assessed using an 11-point numerical rating scale (NRS), where a score of 0 was defined as no pain and a score of 10 as unbearable pain. Ketorolac (30 mg) was administered in cases of severe pain (NRS > 6). If the patient complained of persistent severe pain (NRS > 6) 30 min after ketorolac administration, 1 µg/kg of fentanyl was administered. Quality of recovery was assessed using the Quality of Recovery-40 questionnaire (QoR-40), which was administered 24 h postoperatively. The QoR-40 questionnaire consists of 40 questions, and each question is scored from 1 to 5 for a total of 200 points.