This Letter to the Editor comments on Zhang et al.’s recent study evaluating pyridoxine as part of a multimodal strategy for preventing postoperative nausea and vomiting (PONV) following gynecologic laparoscopic surgery. The authors commend the findings but raise concerns about potential confounding factors and the study’s interpretation.
They note that postoperative analgesia in Zhang et al.’s trial relied entirely on opioids such as sufentanil, dezocine, tramadol, butorphanol, and oxycodone—agents known to increase the risk of PONV. Therefore, improvements attributed to pyridoxine might reflect an indirect effect from reduced opioid exposure rather than a specific antiemetic mechanism. The letter also emphasizes that multimodal opioid-sparing analgesia is a key component of PONV prevention, and future trials should include this in study design.
Additionally, the authors point out that the study did not evaluate other patient-centered outcomes recommended in perioperative medicine, such as sleep quality, time to mobilization, or return of gastrointestinal function. They argue that these endpoints are essential for confirming whether pyridoxine truly improves recovery quality rather than simply reducing nausea incidence.
Finally, they caution that the trial’s secondary findings—such as intraoperative hypotension being more common in the pyridoxine group—warrant further investigation. The authors recommend a larger randomized trial to validate efficacy and safety before adopting pyridoxine broadly in multimodal antiemetic regimens.
What You Should Know
The commentary supports further exploration of pyridoxine for PONV prevention but stresses that opioid-sparing pain control and comprehensive recovery outcomes must be integrated into future studies to ensure accurate interpretation of benefit.
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