Nausea and vomiting after outpatient ACL reconstruction with regional anesthesia: are lumbar plexus blocks a risk factor?

Abstract

Study objective To track the incidence of in-hospital postoperative nausea and vomiting (PONV) requiring postoperative parenteral nursing interventions after outpatient reconstruction of the anterior cruciate ligament (ACL) with one of two types of regional anesthesia to determine the extent to which various anesthetic techniques, preemptive antiemetics, and other factors were associated with the lowest probability of PONV. Design Retrospective chart (database) review of all ACL procedures at the University of Pittsburgh Medical Center from August 1997 through June 1999. Setting University medical center. Measurements We reviewed our institutional database of 347 consecutive patients undergoing ACL reconstruction with either spinal with femoral nerve block (SPI-FNB) or lumbar plexus and sciatic nerve block (LUM-SCI). Recorded variables and outcomes included gender, history of PONV, intravenous (IV) fentanyl before and during surgery, preemptive antiemetics given, and parenteral nursing interventions for PONV performed. Chi-square tests and logistic regression were used to determine factors associated with PONV. Main results For SPI-FNB, PONV incidence was 13% (26/208), but it was higher for LUM-SCI [25%, 34/139, p = 0.002; odds ratio (OR) = 2.2]. Regression modeling demonstrated that women (OR = 2.8, p = 0.003) and LUM-SCI patients (OR = 3.0, p = 0.005) were at greater risk for PONV. The combination of dexamethasone (4 to 10 mg IV) and perphenazine (1.2 to 2.0 mg IV) was associated with less PONV (OR = 0.3, p = 0.005). Type of local anesthetic used for lumbar plexus block was not associated with PONV incidence. Conclusions For ACL reconstruction with regional anesthesia, use of LUM-SCI was associated with a higher rate of PONV, whereas combination antiemetic prophylaxis with perphenazine and dexamethasone was associated with less PONV.