Table 1_Flurbiprofen in patient-controlled intravenous analgesia and the risk of postoperative nausea and vomiting after gynecologic laparoscopy: a retrospective case-control study.docx

AimsTo measure the possible association between flurbiprofen-containing patient-controlled intravenous analgesia (PCIA) and an increased risk of postoperative nausea and vomiting (PONV) following gynecological laparoscopic surgery.
MethodsThe retrospective study was performed on 2,430 patients who underwent a gynecological laparoscopic surgery between April 2021 through May 2022. Perioperative data were extracted from electronic medical records. Multivariable logistic regression was used to identify independent risk factors for PONV, supported by propensity score matching (PSM) and subgroup analyses. A directed acyclic graph (DAG) was constructed to guide confounder selection.
ResultsAmong 2,430 eligible patients, PONV occurred in 27.7% (554/2000) of patients with flurbiprofen-containing PCIA versus 23.0% (99/430) without (absolute risk difference: 4.7%; number needed to harm [NNH] = 21). Multivariable analysis confirmed an independent association between flurbiprofen use and higher PONV risk (adjusted odds ratio [OR] = 1.414, 95% confidence interval [CI] = 1.042–1.918, p = 0.026). Subgroup analysis showed a particularly elevated risk in patients >60 years and those receiving hydromorphone-based PCIA. Notably, despite lower opioid consumption, patients with flurbiprofen had higher PONV incidence.
ConclusionFlurbiprofen-containing PCIA was associated with a modest yet clinically meaningful increase in PONV, especially when combined with hydromorphone. These findings challenge the assumption that NSAIDs are universally protective against PONV and underscore the importance of tailoring multimodal analgesia strategies according to patient risk profiles.