Fospropofol vs Propofol for Early Postoperative Nausea and Vomiting Prophylaxis in High-Risk Patients Undergoing Gynecological Laparoscopic Surgery: A Randomized Controlled Trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication of gynecological laparoscopic surgeries. Although propofol has established antiemetic properties, the efficacy of its water-soluble prodrug, fospropofol, for PONV prophylaxis remains uncertain. The aim of this study was to compare the impact of fospropofol versus propofol on the incidence of PONV in high-risk patients undergoing gynecological laparoscopic surgery. METHODS: In this prospective randomized controlled trial, 102 high-risk (Apfel score ≥3) female patients scheduled for elective gynecological laparoscopy were allocated to receive either fospropofol (FD group, n=51) or propofol (P group, n=51) for induction and maintenance, combined with sevoflurane inhalational anesthesia. The primary outcome was the incidence of PONV within the first 6 h postoperatively. RESULTS: The incidence of PONV at 6 h was significantly lower in the FD group than in the P group (5.9% vs 19.6%; absolute risk reduction, 13.7%; P=0.038). Multivariable logistic regression confirmed that fospropofol was an independent protective factor (odds ratio 0.219; 95% CI 0.045-0.809; P=0.034). No significant between-group differences were observed in the PACU- or 24-h PONV rates. However, the FD group experienced a longer median time to extubation (14.0 vs 10.0 min, P=0.006) and a lower incidence of PACU pain (51.0% vs 72.5%, P=0.025). CONCLUSION: A reduction in early PONV within 6 hours was observed with fospropofol compared to propofol, suggesting a potential role for fospropofol in early PONV prevention. CLINICAL TRIAL REGISTRATION: ChiCTR2500114542.