Frequency Of Postoperative Nausea Research Articles

The effects of alfentanil or remifentanil pretreatment on propofol injection pain

Study objective To compare the efficacy of alfentanil, remifentanil, and saline in minimizing the propofol injection pain. Design Randomized, double-blind study. Setting University hospital. Patients 175 ASA physical status I and II, adult female patients undergoing minor gynecological procedures with general anesthesia. Interventions Unpremedicated patients were randomly allocated to one of four groups. Patients received 2 mL (1 mg) of alfentanil (n = 43), 2 mL of remifentanil 0.01 mg (n = 43), 2 mL of remifentanil 0.02 mg (n = 45), or 2 mL of saline (n = 44) 30 seconds prior to administration 5 mL of propofol 1%. Measurements Patients were asked whether they had pain due to propofol injection. Their pain scores were evaluated with a Visual Analogue Scale. In the Postanesthesia Care Unit, frequency of postoperative nausea, vomiting, hypotension, and flushing were all determined. Main result The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than the saline group ( p < 0.05). When the alfentanil group was compared with the remifentanil groups, significant differences in pain relief associated with injection of propofol ( p < 0.001) were noted. Remifentanil 0.02 mg relieved pain associated with injection of propofol more effectively than remifentanil 0.01 mg ( p < 0.001). Conclusions The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than did the saline group. Remifentanil was effective in preventing propofol injection pain, and should be used at a dose of at least 0.02 mg for this purpose. Remifentanil may be an alternative drug for prevention of propofol injection pain.

Preoperative droperidol improved postoperative pain relief in patients undergoing rotator-cuff repair during general anesthesia using intravenous morphine

Study objective To demonstrate the effect of preoperative and intraoperative, small-dose intravenous (IV) droperidol on postoperative pain relief in orthopedic patients given general anesthesia with morphine. Design Randomized, double-blind, prospective study. Setting University-affiliated hospital. Patients 84 ASA physical status I and II patients undergoing shoulder rotator-cuff repair with general anesthesia. Interventions Patients were randomly assigned to one of three groups: Group P (n = 27) wee given droperidol 10 μg/kg IV before skin incision; Group A (n = 30) received droperidol 10 μg/kg IV after skin incision; and Group C (n = 27) served as controls. General anesthesia consisted of sevoflurane and nitrous oxide in oxygen and IV morphine 0.2 mg/kg, which was given before skin incision. Measurements The degree of postoperative pain as assessed by postoperative pain scores and the number of supplemental analgesics given, and the frequency of postoperative nausea and vomiting, nightmares, and respiratory depression were compared among the three groups. A p- value < 0.05 was considered statistically significant. Main results The postoperative pain score distribution was significantly greater in smaller values in Groups P and A than in Group C (p < 0.01). The number of supplemental analgesics given in the first 18 hours postoperatively was significantly smaller in Group P than in Groups A or C (p < 0.05). Conclusions Preoperative IV droperidol resulted in improved postoperative pain relief inpatients undergoing shoulder rotator cuff surgery with general anesthesia using IV morphine.

Preoperative administration of controlled-release oxycodone for the management of pain after ambulatory laparoscopic tubal ligation surgery

Study Objective: To examine the analgesic efficacy of administering controlled-release (CR) oxycodone 10 mg before elective ambulatory laparoscopic tubal ligation surgery. Design: Randomized, double-blind study. Patients: 50 healthy women presenting for elective ambulatory laparoscopic tubal ligation surgery. Setting: Ambulatory surgery center of a university hospital. Interventions: Fifty patients were administered either placebo (n = 25) or CR oxycodone 10 mg (n = 25) 1 hour before surgery. All patients were administered a similar general anesthetic. In the postanesthesia care unit (PACU), fentanyl 25 μ g was administered for a verbal analog scale (VAS) pain score ≥ 3. Patients were discharged home when they were awake and alert, had stable vital signs, were able to void, tolerated oral fluids, experienced no side effects, had a VAS ≤ 3, and were able to ambulate without assistance. While at home, patients were instructed to take 1 to 2 acetaminophen 325 mg/oxycodone 5 mg tablets, every 3 hours as needed for a VAS ≥ 3. Measurements: VAS pain scores and the frequency of postoperative nausea and vomiting were recorded in the PACU. While at home, patients were contacted by telephone after surgery and asked about their pain score, time to first analgesic use, frequency of postoperative nausea and vomiting, and total acetaminophen/oxycodone use in the 24 hours following surgery. Main Results: Patients in the CR oxycodone group had a shorter time to discharge (p < 0.001), reported lower postoperative pain scores (p < 0.001), lower frequency of postoperative nausea and vomiting (p < 0.05), longer time to first analgesic use (p < 0.0,001), and required less fentanyl in the PACU (p < 0.01) and fewer acetaminophen/oxycodone tablets in the 24 hours following surgery. Conclusion: The preoperative administration of CR oxycodone 10 mg is an effective analgesic technique in the management of pain following ambulatory laparoscopic tubal ligation surgery, and may facilitate earlier postoperative discharge.

Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA)

Study Objective: To compare hemodynamics, recovery profiles, early postoperative pain control and costs of total intravenous anesthesia (TIVA) with propofol and remifentanil and propofol and alfentanil. Design: Randomized, double-blind study. Setting: University hospital. Patients: 40 ASA physical status I and II adult patients scheduled for lumbar discectomy. Interventions: Patients were randomly assigned to receive either remifentanil-propofol or alfentanil-propofol. Anesthesia was induced with remifentanil 1 μ g kg −1 or alfentanil 20 μg kg −1 with propofol 2 mg kg −1 , and maintained with infusions of propofol 150 to 100 μg kg −1 min −1 and either remifentanil 0.1 μg kg −1 min −1 or alfentanil 0.5 μg kg −1 min −1 . Measurements: Hemodynamic parameters (heart rate and mean arterial pressure), times to awakening, and tracheal extubation were recorded. In the postanesthesia care unit, pain level, frequency of analgesic demand, frequency of postoperative nausea and vomiting (PONV), partial oxygen saturation (SpO2), and respiratory rates were noted. Drug dosages and costs of each technique were determined. Main Results: The mean arterial pressure significantly decreased compared to baseline values 1 minute after induction (p < 0.05) in both groups, and it significantly decreased at 5, 15, and 30 minutes perioperatively in the remifentanil group compared to the alfentanil group (p < 0.05). Time of extubation, spontaneous eye opening, and response to verbal command were similar in both groups. Visual analog scale pain scores at 30 minutes and 60 minutes were significantly lower in the alfentanil group than remifentanil group (p < 0.05). At 15, 30, and 60 minutes after terminating the operation oxygen saturation and respiratory rate were significantly higher (p < 0.05) and analgesics were required sooner in the remifentanil group than the alfentanil group (p < 0.05). The frequency of PONV was similar in both groups. The remifentanil-propofol anesthesia was found to be slightly more expensive as compared to the alfentanil based TIVA (33.41 ± 4.53 vs . 29.97 ± 4.1 USD) (p < 0.05). Conclusions: Both remifentanil and alfentanil provided a reasonably rapid and reliable recovery. The remifentanil-based TIVA was associated with high intraoperative cost and early postoperative pain, but it allowed a more rapid respiratory recovery.

Efficacy of ondansetron for prevention of postoperative nausea and vomiting after outpatient ear surgery under local anesthesia

To assess the efficacy and safety of intravenous ondansetron (4 mg) for the prevention of nausea and vomiting after middle ear surgery under local anesthesia.The study was conducted by Division of Otorhinolaryngology in Prince of Wales Hospital, which is a tertiary referral center and teaching hospital for The Chinese University of Hong Kong.A double-blind randomized controlled trial.Fifty-eight Chinese patients undergoing tympanoplasty under local anesthesia from July 1995 to June 1997 were recruited. The mean age of patients was 42.8 years (range 18-71 years).Patients were randomly allocated to receive a single dose of intravenous ondansetron (4 mg) (n = 29) or placebo (n = 29) immediately before surgery.Patients were assessed for severity and frequency of postoperative nausea and vomiting at the 1st, 2nd, 4th, 8th, and 24th hours after middle ear surgery.Female patients showed a higher prevalence of postoperative nausea and vomiting. Twenty-eight percent of the patients experienced postoperative nausea, of whom 14% also experienced vomiting. Although the ondansetron group demonstrated a lower prevalence of postoperative nausea and vomiting (PONV) (24% nausea and 10% vomiting) than the placebo group (31% nausea and 17% vomiting), significant reduction in postoperative vomiting only occurred in the first postoperative hour (p = 0.038). No complications or adverse side effects were found to be associated with the use of ondansetron.Single-dose ondansetron (4 mg) given intravenously preoperatively significantly reduces postoperative vomiting in patients after tympanoplasty under local anesthesia and causes no adverse effects.

Patient-maintained analgesia with target-controlled alfentanil infusion after cardiac surgery: a comparison with morphine PCA

The performance of a patient-demand, target-controlled alfentanil infusion system was compared with that of a traditional morphine patient-controlled analgesia (PCA) pump in 120 adult patients after cardiac surgery. Patients were randomized to one of the two PCA systems for their postoperative analgesia in the intensive care unit and pain, nausea and sedation scores were recorded every 4 h for the first 24 h. Episodes of hypoxaemia, myocardial ischaemia and haemodynamic instability were also recorded. In patients using the alfentanil system the overall median visual analogue pain score was 2.3 (95% Cl 2.3-2.8) compared with 3.0 (95% Cl 2.7-3.2) in those using morphine PCA (P < 0.05), but both systems delivered high-quality analgesia. The two groups did not differ with respect to the overall sedation scores, the frequency of postoperative nausea and vomiting, haemodynamic instability, myocardial ischaemia or hypoxaemia.

Role of Nitrous Oxide and Other Factors in Postoperative Nausea and Vomiting

Postoperative nausea and vomiting have been reported to be associated with the use of nitrous oxide. To further investigate this possibility, 780 patients undergoing anesthesia and surgery were randomly divided into four groups: group I: enflurane/nitrous oxide/oxygen; group II: enflurane/air/oxygen; group III: isoflurane/nitrous oxide/oxygen; and group IV: isoflurane/air/oxygen. The frequency of postoperative nausea and vomiting was ascertained in the recovery room and at 24-h follow-up by blinded observers. Other data collected included gender, age, body mass index, previous history of postoperative nausea and vomiting, and postoperative narcotic use. The authors found no association between the use of nitrous oxide and subsequent development of postoperative nausea and vomiting. Use of the 95% confidence interval allowed the authors to project a maximum potential increase in the frequency of postoperative nausea and vomiting associated with nitrous oxide to be 5.4% with enflurane and 9.7% with isoflurane in the immediate postoperative period. Female gender, younger age, and a previous history of postoperative nausea and vomiting, but not body mass index, were found to be associated with postoperative nausea and vomiting (P less than 0.05). It is concluded that there is no association between the use of nitrous oxide and the development of postoperative nausea and vomiting.

Nausea and vomiting after ocular surgery.

The frequency of postoperative nausea and vomiting following common ocular operations was studied in 110 male and 125 female patients anaesthetized by four different techniques: N2O‐ O2‐relaxant anaesthesia, neurolept analgesia, N2O‐O2‐halothane anaesthesia, and local anaesthesia with 2% mepivacaine. There were no significant differences between these various techniques in regard to the frequency of nausea and vomiting, although local anaesthesia seemed to give the best results in this respect.In the second part of the study, the antiemetic effect of dehydrobenzperidol was studied in 127 male and 175 female patients. A dose of 2.5 mg of this drug was effective in preventing postoperative vomiting both after N2O‐O2‐relaxant anaesthesia and, more distinctly, after local anaesthesia.