Abstract
BackgroundThe preemptive multimodal pain protocols used in total knee arthroplasty (TKA) often cause emesis postoperatively. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA.MethodsWe randomized 120 female patients undergoing TKA to receive either palonosetron (0.075 mg, intravenous) or no antiemetic prophylaxis (0.9% saline, control group). All patients were given spinal anesthesia, a continuous femoral nerve block, and fentanyl-based intravenous patient controlled analgesia. Patients undergoing staged bilateral TKA were assigned to one group for the first knee and the other group for the second knee. The overall incidence of PONV, the incidences of both nausea and vomiting, severity of nausea, complete response, requirement for rescue antiemetics, pain level, opioid consumption, and satisfaction scores were evaluated during three periods: 0–2, 2–24, and 24–48 h postoperatively. We also compared PONV and pain between the first and second TKA.ResultsThe incidence of PONV during the first 48 h was lower in the palonosetron group compared with the controls (22 vs. 41%, p = 0.028), especially 2–24 h after surgery, as was the nausea and vomiting respectively. The severity of nausea was lower in the palonosetron group (p = 0.010). The complete response rate (93 vs. 73%, p = 0.016) and satisfaction score (84 ± 12 vs. 79 ± 15, p = 0.032) were higher in the palonosetron group during 2–24 h after surgery. Patients who underwent a second operation complained of more severe pain, and consumed more opioids than those of the first operation. There was no difference in the incidence of PONV between the first and second operations.ConclusionsPalonosetron prophylaxis reduced the incidence and severity of PONV in high-risk patients managed with multimodal pain protocol for 48 h, notably 2–24 h after TKA.
Highlights
The incidence of postoperative nausea and vomiting (PONV) in patients undergoing arthroplasty ranges from 68% to 83% in patients not given prophylactic antiemetics [1]
The incidence of PONV during the first 48 h was lower in the palonosetron group compared with the controls (22 vs. 41%, p = 0.028), especially 2–24 h after surgery, as was the nausea and vomiting respectively
There was no difference in the incidence of PONV between the first and second operations
Summary
The incidence of postoperative nausea and vomiting (PONV) in patients undergoing arthroplasty ranges from 68% to 83% in patients not given prophylactic antiemetics [1]. The multimodal pain protocols, using more than one analgesic with different mechanisms due to the limited effects of single-drug therapy [2,3], are widely used to relieve pain after total knee arthroplasty (TKA). Various methods are recommended to decrease PONV, including prophylactic antiemetics, regional anesthesia, propofol, oxygen, fluid infusion, minimal opioid use, and corticosteroids [1,7]. Despite these preventive methods, the incidence of PONV (40%) after TKA is still high [8]. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA
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