Incidence Of Postoperative Nausea Vomiting Research Articles

Comparison of Analgesic Efficacy of Ultrasound Guided PEC II Block Using Dexamethasone as an Adjuvant to Ropivacaine Versus Plain Ropivacaine in Patients Undergoing Modified Radical Mastectomy: A Double-Blind, Randomized Controlled Trial.

Pain after breast cancer surgery is one of the main reasons for postoperative morbidity and pulmonary complications leading to increased hospital stay. Therefore, effective management of postoperative pain becomes necessary to alleviate patients' suffering and allow early mobilization and hospital discharge. Traditionally, opioids have been used to manage perioperative pain but they are associated with side effects. So, an opioid-sparing multimodal analgesia approach is used nowadays. Ultrasound-guided pectoral type-II (PEC II) block is increasingly being used to address acute postoperative pain after breast cancer surgery. However, to date, not many studies have been done regarding prolonging the duration of analgesia of PEC II blocks for postoperative pain relief in patients undergoing modified radical mastectomy (MRM). So, we undertook this study to compare the analgesic efficacy of PEC II block using dexamethasone as an adjuvant to ropivacaine versus plain ropivacaine in patients undergoing MRM. After obtaining approval from the institute ethics committee and written informed consent from the patients, this prospective, double-blind, parallel group, randomized controlled study was carried out at All India Institute of Medical Sciences (AIIMS) Raipur, from March 2021 to March 2022. Sixty-four female patients, aged 18 years and above, belonging to the American Society of Anesthesiologists, physical status I, II, and III, undergoingunilateral, elective MRMunder general anesthesia, were randomly allocated to two groups A and B, with 32 patients in each to receive30 mL of 0.25% ropivacaine plus 2 mL (8 mg) of dexamethasone and 30 mL of 0.25% ropivacaine plus 2 mL of normal saline, respectively. The primary outcome measure was total opioid consumption till 12 hours postoperatively. Secondary outcome measures were the difference in pain scores based on the numeric rating scale till 12 hours postoperatively, post-operative sedation scores, the incidence of postoperative nausea vomiting (PONV), and other adverse events (if any). The mean (SD) of morphine (mg) consumed intraoperatively was 5.50 (1.05) and 5.95 (0.86) with P = 0.033 and that consumed postoperatively was 1.00 (0.00) and 1.69 (0.93) with P <0.001 in group A and B respectively, with morphine consumption being higher in the group. The difference in the NRS score for pain at rest was statistically significant at 2 h (P=0.030), 4 h (P=0.004), 6 h (P=0.002), and, 12 h (P=0.039) time points with the score being higher in group B. The groups were comparable in terms of postoperative sedation score (P > 0.05) and incidence of postoperative nausea and vomiting. None of the patientsin group A and 6.2% of the patients in group B had nausea (P = 0.492). None of the patients in either of the groups had vomiting. No other complication occurred during the entire study in either of the groups. In comparison to plain ropivacaine, the addition of dexamethasone as an adjuvant to ropivacaine for PEC II block in patients undergoing MRM significantly reduced perioperative opioid consumption and postoperative NRS scores. No significant change was noted in terms of postoperative sedation score, incidence of PONV, and other side effects between the groups. Therefore, we conclude that the analgesic efficacy of US-guided PEC II block using dexamethasone, as an adjuvant to ropivacaine is superior to that of plain ropivacaine in patients undergoing MRM.

Overview of the Incidence of Post Operative Nausea and Vomiting in Spinal Anesthesia for Sectio Caesarea Patients in the Recovery Room of Fatimah Cilacap Islamic Hospital

Background: Post operative nausea vomiting (PONV) is nausea and vomiting that occurs after surgery and before the patient returns from the hospital. PONV must be taken seriously because it can have an impact on the length of the patient's recovery period, hamper activities, and increase the cost of care that must be incurred. PONV or nausea and vomiting. Aim: what is the description of the incidence of PONV in spinal anesthesia in SC patients in the recovery room (RR) RSI Fatimah Cilacap. Method: Quantitative descriptive with a cross section approach, the sample used total sampling of 31 respondents instruments using the Simplified Postoperative Nausea and Vomiting Impact Scale for Audit and Post-Discharge. Findings: PONV sufferers were 19 respondents (59.4%), based on age 26-34 years as many as 16 respondents (51.6%), at BMI the incidence of PONV was obese as many as 11 respondents (35.5%), in the length of surgery the most PONV was found in women as many as 4 respondents (11.4%), in the length of surgery the incidence of PONV was found to be mostly 1-2 hours as many as 10 respondents (32.3%), and in the previous PONV history the incidence of PONV was found to have all experienced PONV before as many as 13 respondents (16.1%). Conclusion: the frequency distribution of PONV incidence on respondents who are female, obese IMT operation duration and PONV history with spinal anesthesia technique in cesarean section surgery.

Ultrasound-Guided Suprazygomatic Maxillary Nerve Block Is Effective in Reducing Postoperative Opioid Use Following Bimaxillary Osteotomy

Ultrasound-guided maxillary nerve block has recently been described, though its impact upon bimaxillary osteotomy has not been formally investigated. The present study was carried out to determine whether the addition of ultrasound-guided maxillary nerve block in subjects undergoing bimaxillary osteotomy reduces opioid use. A randomized clinical trial was carried out in adults undergoing bimaxillary osteotomy between April 2019 and January 2020 at Teknon Medical Center (Barcelona, Spain). The predictor variable was the treatment technique used (maxillary nerve block or no block). The subjects were randomized to either receive (test group) or not receive (control group) bilateral ultrasound-guided suprazygomatic maxillary nerve block (5ml of 0.37% ropivacaine) before surgery. The primary outcome variable was the intravenous methadone requirements in the first two postoperative hours. The secondary outcome variables were postoperative pain, rescue subcutaneous methadone, intravenous remifentanil used intraoperatively, the incidence of postoperative nausea-vomiting, and complications derived from maxillary nerve block. Subject age, sex, weight, height, and anesthetic risk, and the duration of surgery were recorded. Descriptive and inferential analyses were performed using the χ2 test and Mann-Whitney U test. Statistical significance was considered for P<.05. The baseline sample consisted of 68 subjects scheduled for bimaxillary osteotomy. The follow-up sample comprised 60 subjects: 30 in the control group (10 females and 20 males, aged 34.0±10.2years) and 30 in the test group (13 females and 17 males, aged 29.8±10.8years). The subjects who received maxillary nerve block showed less intravenous methadone use in the first 2hours postsurgery (median 2.0mg control group vs 0mg test group; P<.001), lower pain levels at any time during the first 18hours postsurgery (median visual analog score 4 control group vs 2 test group; P<.001), and a lesser percentage required methadone (33.3% control group vs 0% test group; P<.01) at 4-18hours postsurgery. The results obtained suggest that ultrasound-guided maxillary nerve block is a promising anesthetic technique capable of reducing intraoperative and postoperative opioid use, with greater patient comfort in bimaxillary osteotomy.

Comparison of the effects of opioid-free anesthesia (OFA) and opioid-based anesthesia (OBA) on postoperative analgesia and intraoperative hemodynamics in patients undergoing spine surgery: A prospective randomized double-blind controlled trial.

Opioids form the basis of perioperative pain management but are associated with multiple side effects. In opioid-free anesthesia (OFA), several non-opioid drugs or neuraxial/regional blocks are used as substitutes for opioids. Ketamine, a N-methyl-d-aspartate antagonist, provides intense analgesia. However, there is a shortage of literature on the effects of ketamine-based OFA on hemodynamics (HD) and postoperative analgesia in patients undergoing thoracolumbar spine surgery. This prospective randomized controlled trial included 60 adult patients. The patients in Group OFA (n = 30) received OFA with ketamine and ketofol (1:5) infusion, and those in Group OBA (n = 30) received opioid-based anesthesia (OBA) with fentanyl and propofol infusion. The postoperative pain-free period, pain scores, rescue analgesia, intraoperative HDs, and postoperative complications were assessed. The mean pain-free period in Group OFA (9.86 ± 1.43 hr) was significantly higher than that in Group OBA (6.93 ± 1.93 hr) (P = 0.002). During the postoperative 48 hours, the total requirement of fentanyl was considerably lower in Group OFA (P < 0.05). There was a significantly higher incidence of hypertension in Group OFA (46%) and hypotension (43%) in Group OBA (43%), respectively. Postoperative nausea vomiting (PONV) was more common in Group OBA at the 2nd and 6th hr (P = 0.046 and P = 0.038). OFA with ketamine and ketofol provided adequate postoperative analgesia with a lower incidence of PONV after spine surgery. However, hypertension in the ketamine group and hypotension in the propofol group required fine titration of the infusion rate of drugs during the intraoperative period.

Perioperative use of low dose haloperidol safely reduces episodes of postoperative nausea/vomiting and length of stay following elective minimally invasive bariatric surgery.

While total intravenous anesthesia (TIVA) protocols include Dexamethasone and Ondansetron prophylaxis, bariatric patients continue to be considered at particularly high risk for postoperative nausea/vomiting (PONV). A multimodal approach for prophylaxis is recommended by the Bariatric Enhanced Recovery After Surgery (ERAS) Society however, there remains a lack of consensus on the optimal strategy to manage PONV in these patients. Haloperidol has been shown at low doses to have a therapeutic effect in treatment of refractory nausea and in PONV prophylaxis in other high risk surgical populations. We sought to investigate its efficacy as a prophylactic medication for PONV in the bariatric population andto identify which perioperative strategies were most effective at reducing episodes of PONV. An institutional bariatric database was created by retrospectively reviewing patients undergoing elective minimally invasive bariatric procedures from 2018 to 2022. Demographic data reviewed included age, gender, preoperative body mass index (BMI), ethnicity, and primary language. Primary endpoints included patient reported episodes of PONV, total doses of Ondansetron administered, need for a second antiemetic (rescue medication), complication rate (most commonly readmission within 30days), and length of stay. Fisher's exact test, Mann-Whitney test, and ANOVA were used to evaluate the effect of perioperative management on various endpoints. A total of 475 patients were analyzed with Haloperidol being utilized in 15.8% of all patients. Patients receiving Haloperidol were less likely to require Ondansetron outside of the immediate perioperative period (34.7% vs. 49.8%, p = 0.02), experienced less PONV (41.3% vs. 64.3%, p = 0.01) and also had a decreased median length of stay (27.3 vs. 35.8h, p < 0.0001). Addition of low dose Haloperidol to Bariatric ERAS protocols decreases incidence of PONV and the need for additional antiemetic coverage resulting in a significantly shorter length of stay, increasing the likelihood of safe discharge on postoperative day 1.

Effect of single dose preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables and post-operative nausea, vomiting, and pain in open cholecystectomy done under general anesthesia: A prospective, randomized, and single-blind study

Background: Pain due to open cholecystectomy can result in delayed recovery and poor operative outcomes. Multimodal approaches to pain control cause functional improvement. We compared the efficacy of paracetamol 1 g, dexamethasone 8 mg, and magnesium sulfate 2 g with normal saline in control over perioperative hemodynamics and post-operative pain in patients undergoing open cholecystectomy under general anesthesia. Aims and Objectives: This study conducted to assess the effect of preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables (primary outcome) and post-operative nausea, vomiting, and pain (secondary outcome) in open cholecystectomy. Materials and Methods: Sixty patients of ASA Grade I/II were randomized into two groups to receive either normal saline 100 ml iv (Group C, n=30) or infusion containing inj. paracetamol 1 g, inj. dexamethasone 8 mg and inj. magnesium sulfate 2 g iv (group PDM, n=30), 20 min before induction. Intraoperative and post-operative hemodynamic data, post-operative pain scores, and incidence of nausea vomiting were recorded. Results: Intraoperative pulse rate was significantly higher at intubation and 15 min after intubation in the control group and intraoperative systolic, diastolic, and mean arterial blood pressure were significantly higher in control group at intubation and until 60 min. Post-operative pulse rate was significantly higher in the control groups at 180 min and incidence of PONV reduced in PDM group until 90 min. Conclusion: Preemptive intravenous infusion of paracetamol, dexamethasone, and magnesium sulfate provided better stability over perioperative hemodynamics, reduced the incidence of post-operative nausea vomiting, and provided better post-operative pain control.

Anesthetic Depth Monitoring Decreased the Incidence of Postoperative Delirium Assessed in Nursing Delirium Screening Scale in Elective Non-Cardiac Surgical Patients Receiving Intravenous Patient-Controlled Analgesia

Background To identify the impact of processed electroencephalogram (pEEG)-guided anesthesia on postoperative delirium (POD) assessed by NuDESC, postoperative analgesic requirements, and the incidence of postoperative nausea/vomiting (PONV) in the elective non-cardiac surgical patients with intravenous patient-controlled analgesia (IVPCA) in the wards. Methods In this retrospective observational study, the anesthesiologists were free to use M-Entropy™, an pEEG device, to monitor the depth of anesthesia intraoperatively during the period (September 2015 ~ February 2018). Acute pain service team assessed the analgesic/side effects of IVPCA and POD at least twice daily for 3 days postoperatively. POD was screened by Nursing Delirium Screening Scale (NuDESC) (0-10). Pain severity was measured by an 11-point verbal numerical rating scale (0–10). Results A total of 1178 patients (≧60 years) were enrolled and divided to Entropy (749 patients) vs. non-Entropy group (429 patients). Multivariate logistic analysis showed that age (≧70), surgical types (non-joint), intraoperative highest minimum alveolar concentration (MAC) (&lt;0.9MAC) and the POD incidence were independent predictors for group differences (multiple odds ratio and 95% confidence interval: 5.99, 4.34-8.29; 2.01, 1.49-2.72; 6.84, 4.38-10.67; 0.09, 0.04-0.19). The POD incidence in Entropy group (2.2%, 17 patients) was significantly lower than that in non-Entropy group (6.7%, 29 patients) (p &lt;0.001). However, pEEG-guided anesthesia did not affect the phenomenological characteristics of POD. In addition, intraoperative pEEG-guided anesthesia did not reduce total morphine dose of IVPCA, the incidence of PONV and pain severity. Conclusions Processed EEG-guided anesthesia decreased POD incidence assessed in NuDESC in IVPCA patients undergoing elective non-cardiac surgery returning to the common ward. In addition, it did not reduce postoperative pain severity, postoperative analgesic requirements and PONV incidence. More researches are needed to investigate the effects of pEEG-guided anesthesia on POD and other postoperative conditions.

Göğüs cerrahisi ameliyatı geçiren torakal epidural kateter takılan hastalarda postoperatif bulantı/kusmayı öngörmedeki parametreler

Aim: In thoracic surgery, many factors; such as long duration of surgery and the use of volatile anesthetics may increase the frequency of postoperative nausea/ vomiting (PONV). Recent studies suggests that inflammatory markers such as neutrophils lymphocytes ratio (NLR) can predict PONV. The aim of this study is to postoperatively examine the role of demographic, laboratory, and clinical data in predicting PONV in patients who underwent thoracotomy and received thoracic epidural analgesia (TEA).&#x0D; Material and Methods:Data were collected for patients who underwent elective thoracic surgery and were administered TEA between March 2017 and December 2020. Patients' demographic data, laboratory parameters, and clinical characteristics; such as American Association of Anesthesiologists (ASA) I-II-III, erythrocyte distribution width (RDW), NLR, postoperative visual analog scale (VAS), were scanned. All patients who developed PONV were included in Group 1. Hospital records were used to select Group 2 patients who did not develop PONV.&#x0D; Results: The incidence of PONV was determined as 14.77%. There was a statistically significant difference between the groups in terms of ASA and 24-hour VAS scores (p &lt; 0.05). Patients with PONV had statistically significantly higher 24-hour VAS scores(p &lt; 0.05). PONV was statistically significantly higher in patients with ASA III compared to other ASA groups (p &lt; 0.05). Multivariate analysis suggests that ASA, RDW and 24-hour VAS are significant in predicting PONV. Lower RDW, higher ASA and 24-hour VAS increase the risk of PONV.&#x0D; Conclusion: Demographic data, laboratory parameters, and clinical characteristics were evaluated concerning their correlation with PONV in this study. It was observed that the frequency of PONV might increase in patients with low RDW levels. In addition, higher VAS values and ASA physical score were also found to increase the risk of PONV in patients who underwent thoracotomy and administered TEA

Abstract No.: ABS1042: A Randomised Controlled Trial To Compare The Occurrence Of Postoperative Nausea And Vomiting In Early Versus Conventional Feeding In Children Undergoing Day Care Surgery Under General Anaesthesia

Background & Aims:Practice of postoperative fasting of 4-6 hours in children has no specific evidence. We planned this study to assess postoperative nausea vomiting (PONV) with early oral feeding as compared to conventional feeding in children undergoing day care surgery under general anaesthesia (GA)Methods:This was a randomised controlled trial, conducted after approval by Institutional Ethical Committee, registered in Clinical TrialsRegistry of India (CTRI No - CTRI/2020/01/022789). Three hundred children were randomised into group of early feeding (EF, n=150) or conventional feeding (CF, n=150). Standardised general anaesthesia was induced. Postoperatively, group EF received carbohydrate feed on demand, group CF received feed after 4-6 hours. Maximum feed given was 10 ml/kg body weight. Time, volume of first postoperative feed, incidence of PONV, postoperative pain [by Face,Legs,Activity,Cry,Consolability (FLACC Score)after the first feed, complications and parents satisfaction were recorded.Results:Time to first postoperative feed was 64.87 minutes in group EF and 273.28 minutes in group CF (p < 0.001). Incidence of PONV was comparable (EF vs CF = 12% vs 18.7%, p = 0.109). Difference in mean FLACC score were significant at 0 minutes, 30 minutes and 1 hour (p <0.001). Group EF had significantly shorter hospital stay (7.31 vs 11.13 hours, p =<0.001) and significantly better parental satisfaction score (p <0.001Table 1Demographic ProfilePatient characteristicsMean±SDP* Group EF (n=150)Group CF (n=150)Age (years)6.46±2.486.58±2.640.794aWeight (kg)19.79±6.9619.90±6.470.635aGender Male102 (68%)48 (32%)0.149b Female90 (60%)60 (40%)Conclusion:Early postoperative feeding in children is safe and does not increase the incidence of PONV as compared to conventionalfeeding and is associated with shorter duration of hospital stay and improved parental satisfaction.Table 2Postoperative NauseaVomiting (PONV) and FeedsCharacteristicsGroup EF (n=150)Group CF (n=150)P*Incidence of PONV18 (12%)28 (18.7%)0.109aVolume of Feed (ml)22.45±9.0423.21±6.740.080bType of Feed 5% Dextrose40 (26.7%)40 (26.7%)0.999a Orange juice39 (26.0%)39 (26.0%) Apple juice37 (24.7%)38 (25.3%) Mango drink34 (22.7%)33 (22.0%)Time to 1st Feed (mins)64.87±44.24273.28±34.87<0.001bEpisodes of PONV 0132 (88.0%)122 (81.3%)0.215c 114 (9.3%)24 (16.0%) 24 (2.7%)4 (2.7%)Vomiting Score0.23±0.660.36±0.800.107bDose of Antiemetics (Ondansetron, mg)0.19±0.550.36±0.810.084baChi-squared test, bWilcoxon-Mann-Whitney U test, cFisher’s Exact test

Comparing the Incidence of Postoperative Nausea Vomiting (PONV) after Total Intravenous Anesthesia (TIVA) versus Volatile Maintenance Anesthesia (VMA): A Randomized Controlled Trial in Laparoscopic Cholecystectomy or Gynecological Laparoscopic Surgery

Background: Postoperative nausea and vomiting (PONV) adversely affects the surgical outcome. According to the Apfel score, there is a direct correlation between anesthetic agents and PONV. Currently, it is well-known that PONV is higher in patients receiving volatile maintenance anesthesia (VMA) than those receiving total intravenous anesthesia (TIVA). The present study compared the incidence of PONV in moderate to high PONV risk patients between propofol and sevoflurane anesthesia. Objective: To study the incidence of early and delayed PONV among the patients with Apfel score &gt;2 undergoing laparoscopic cholecystectomy (LC) or gynecological laparoscopic surgery comparing between TIVA and VMA techniques, from June to November 2019. Primary outcome was the incidence of PONV at the post-anesthesia care unit (PACU) and 24 hours after surgery. Secondary outcome was the incidence of intraoperative hypotension, extubation time and fentanyl consumption in PACU. Materials and Methods: A single-center, randomized controlled involving 75 patients with American Society of Anesthesiologists (ASA) 1 to 3, age 18 to 85 years, Apfel score &gt;2 who underwent LC or gynecological laparoscopic surgery. Patients were randomly assigned to receive TIVA (n=36) or VMA (n=39). Intraoperative, TIVA were maintained with propofol 2 to 12 mg/kg/min, and VMA were maintained with exhaled sevoflurane of 1.5 to 2.5%. The bispectral index (BIS) was maintained between 40 and 60. Incidence(s) of early and delayed PONV were recorded. Results: Patient characteristics were similar in both groups. The incidence of PONV was not significantly different; early PONV: TIVA = 13.9%, VMA = 28.2% (p=0.131); delayed PONV: TIVA = 27.8%, VMA = 28.2% (p=0.967). For the secondary outcomes which are intraoperative hypotension (p=0.343), extubation time (p=0.598), and fentanyl consumption at PACU (p=0.855) were also not significantly different. Conclusion: There was no significant difference in PONV incidence between TIVA and VMA techniques in laparoscopic cholecystectomy or gynecological laparoscopic operation. Keywords: Laparoscopic surgery; PONV; Total intravenous anesthesia; Volatile maintenance anesthesia

Comparative study of efficacy of palonosetron, dexamethasone and glycopyrrolate in prevention of postoperative nausea and vomiting in patients undergoing lower abdominal surgeries under spinal anesthesia using bupivacaine with morphine

Introduction: Incidence of post-operative nausea vomiting (PONV) after spinal anesthesia is 21%, which increases to 50% when we add opioid (morphine) adjuvant intrathecally for better analgesia. This study is oriented to search a remedy for this commonest postoperative complication and to compare the efficacy of intravenous Palonosetron, Dexamethasone and Glycopyrrolate given preoperatively in prevention of PONV with intrathecal hyperbaric bupivacaine with morphine, in lower abdominal surgeries. Methods: After Ethical committee clearance, Informed written consent was obtained from 90 ASAI or II patients, between ages 18 and 65 years undergoing surgery under spinal anaesthesia and randomized into three groups to receive either injection Palonosetron 0.075 mg (Group P), injection Dexamethasone 8mg (Group D) or injection Glycopyrrolate 0.2mg (Group G) 15 minutes prior to spinal anesthesia with injection bupivacaine 0.5% hyperbaric 15mg with 100 micrograms preservative free morphine and observed for complete responders, number of episodes of vomiting post operatively over 48 hrs. Pain and sedation assessed by Visual analogue score & Ramsey Sedation Scale respectively. Injection ondansetron 4mg is used as rescue drug. Results: Demographic data and hemodynamic variables were similar in all the groups. The incidence of PONV in Palonosetron and Glycopyrrolate group was13.3 % & in Dexamethasone group was16.7% with p value 0.6 which was similar. Conclusion: The efficacy of premedication with i.v. Dexamethasone or Glycopyrrolate in lower abdominal surgeries in prevention of PONV was comparable with Palonosetron.

Comparative study of efficacy of intravenous dexamethasone and glycopyrrolate in prevention of PONV with intrathecal bupivacaine with morphine, in lower abdominal surgeries: A prospective randomised double blind study

Introduction: Intrathecal Morphine as adjuvant can provide safe and effective post-operative analgesia for up to 24 hours. Incidence of post-operative nausea vomiting (PONV) after spinal anesthesia is 21%, which increases to 50% when we add opioid (morphine) adjuvant. This study is oriented to search a remedy for PONV and to compare the efficacy of intravenous Dexamethasone and Glycopyrrolate given preoperatively in prevention of PONV with intrathecal hyperbaric bupivacaine with morphine, in lower abdominal surgeries. Methods: After Ethical committee clearance, Informed written consent was obtained from 60 ASA I or II patients, between ages 18 and 65 years undergoing surgery under spinal anaesthesia and randomized into two groups to receive either injection Dexamethasone 8 mg (Group D) or injection Glycopyrrolate 0.2 mg (Group G) 15 minutes prior to spinal anesthesia with injection bupivacaine 0.5% hyperbaric 15 mg with 100 micrograms preservative free morphine and observed for complete responders, number of episodes of vomiting post operatively over 48 hrs. Pain and sedation assessed by Visual analogue score & Ramsey Sedation Scale respectively. Injection ondansetron 4 mg is used as rescue drug. Results: Demographic data and hemodynamic variables were similar in all the groups. The incidence of PONV in Glycopyrrolate group was 16% & in Dexamethasone group was 12% with p value 0.5 which was similar. Conclusion: The efficacy of premedication with i.v. Dexamethasone or Glycopyrrolate in lower abdominal surgeries in prevention of PONV was comparable.

Comparison of the Incidence of Nausea and Vomiting in the Administration of Tramadol 100 mg Suppositories with Intravenous Post-Spinal Anesthesia for Lower Extremity Surgery

Pendahuluan : Post operative nausea vomiting (PONV) pasca pemberian tramadol Postoperative nausea vomiting (PONV) after intravenous administration of tramadol has a high incidence rate, so it needs alternative drug administration to overcome this problem. This study aims to compare the incidence of postoperative nausea and vomiting in the intravenous administration of tramadol suppositories. A double-blind analytical experimental study, involving 36 subjects divided into tramadol suppositories and intravenous tramadol post-extremity surgery with spinal anesthesia at Haji Adam Malik Hospital and Network Hospital in 2013. The incidence of PONV in tramadol suppository subjects was much lower than in intravenous tramadol subjects.

Effectiveness of the Use of Acupressure Wristband at Neiguan Point (P6) Towards Postoperative Nausea Vomiting (PONV) in Orthopedic Surgical Patients

Postoperative nausea and vomiting (PONV) is one of the most common causes of patient discomfort after undergoing surgery. The emergence of PONV allows the emergence of various complications including dehydration, electrolyte imbalance, slowing the wound healing process, the emergence of problems related to nutritional fulfillment to pneumonia aspiration. Pharmacological treatment has been done but it has not been effective and there are side effects of drugs used so that we need a complementary therapy that works synergistically with antiemetic therapy, namely acupressure. This study aimed at determine the effectiveness of the use of acupressure wristband at neiguan point (p6) towards postoperative nausea vomiting (ponv) in orthopedic surgical patients at BIMC Hospital Kuta. The study design was a pre-experimental with non-randomized uncontrolled trial with pretest-posttest without control group design, with a total of 19 research subjects included in the inclusion criteria. The research instrument consisted of two questionnaires namely the patient information form and the RINVR questionnaire (Rhodes Index of Nausea Vomiting and Retching). The results showed that the incidence of PONV before being given an intervention was obtained by 12 people (63.2%) had mild nausea and vomiting 7 people (36, 8%) experience moderate nausea and vomiting. Whereas after being given the intervention obtained as many as 6 people (31.6%) did not experience nausea, vomiting, 12 people (63.2%) experienced mild nausea, and 1 (5.3%) experienced moderate nausea and vomiting. Wilcoxon test results showed there is the effect of the use of acupressure wristband at neiguan point (p6) towards postoperative nausea vomiting (PONV) in orthopedic surgical patients at BIMC Hospital Kuta

Safety and Efficacy of Low-dose Selective Spinal Anesthesia with Bupivacaine and Fentanyl as Compared to Intravenous Sedation and Port-Site Infiltration for Outpatient Laparoscopic Tubal Ligation: A Randomized Controlled Trial.

Background:Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation.Aims:We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures.Settings and Design:100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups.Materials and Methods:In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg-1.h-1 and in Group C i.v. fentanyl at 1μg.kg-1.h-1 along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse.Statistical Analysis:Continuous variables between the groups were compared by the independent t-test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value.Results:Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg-1 compared to group S 0.79 (±0.53) μg.kg-1. Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S.Conclusion:Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption.

Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy

Background and Aims:Regional anaesthesia attenuates surgical stress-response, provides superior analgesia, reduces recovery time with early mobilisation and is opioid-sparing [addresses post-operative nausea vomiting (PONV), constipation, immunosuppression and cancer-progression concerns with opioids]. Hence, we studied pectoralis (PECS) blocks for modified radical mastectomy (MRM).Methods:A prospective, interventional, double-blind, randomised, parallel-arm, active-controlled study comparing two anaesthetic techniques for post-operative pain relief in70 adult American Society of Anesthesiologists grade I/II carcinoma breast patients undergoing MRM was conducted. Patients were randomised to Group-O (opioids, sevoflurane) and Group-P (PECS-block, pre-incisional intravenous (IV) ketamine (0.5 mg/kg), pre-incisional IVdexmedetomidine (1 μg/kg over 10 min, then 0.6 μg/kg/h). Data were subjected to statistical analysis using the Statistical Package for Social Sciences, version-23 and independent sample t-test/Welch test for equality of means and expressed as dotted box-whisker plots. Nominal categorical intergroup data was compared using Chi-squared test/Fisher's exact test. P<0.05 was considered statistically significant. Clinical significance was calculated.Results:Higher Visual Analogue Scale (VAS)-scores were recorded in Group-O versus Group-P, immediately post-extubation [mean (SD) 3.6 ± 1.5 and 0.76 ± 0.6] and at 1h (3.1 ± 1.2 and1.4 ± 0.5), 2h (2.5 ± 0.9 and 1.2 ± 0.6) and 4h (2.2 ± 0.5 and 1.7 ± 0.9) respectively. At 8h and 24h post-surgery VAS was comparable. Cumulative-VAS was lower in Group-P. Intraoperative haemodynamics were comparable. Incidence of PONV and constipation was higher in Group-O where each patient received average 27.46 mg morphine-equivalents of opioids. Time to discharge from surgical intensive care unit was 2h shorter in Group-P.Conclusion:Pre-emptive PECS-blocks supplemented with low-dose ketamine and dexmedetomidine comprise a practical and useful alternative technique to the standard opioid-based general anaesthetic technique for MRM.

Effectiveness of intravenous dexamethasone on fascia iliaca compartment block with bupivacaine as part of postoperative multimodal analgesia for an open reduction and internal fixation surgery of femoral fracture in Hawassa Comprehensive Referral Hospital, Ethiopia, 2019: A randomized controlled trial

BackgroundFascia iliaca compartment nerve block is used for open reduction and internal fixation surgery of femoral fracture. Though dexamethasone is added to peripheral nerve block to increase analgesia efficacy but its effect on fascia iliaca is not known. MethodA randomized control trial conducted in Hawassa University Comprehensive Specialized Hospital by recruiting 60 patients. Mann Whitney U test was used for distribution free data and independent t-test was used for normally distributed numeric data respectively. Categorical variable between two groups were analyzed using chi-square or fisher exact test. Data was expressed in terms of mean ± standard deviation for normally distributed data or median (inter quartile range) for skewed data. p -value <0.05 is considered statically significant. ResultsThere were statistically significant differences between the groups in time to first analgesia request p-value of = 0.003, tramadol, diclofenac and morphine consumption with p-value of, 0.017, 0.036 and 0.046 respectively. Regarding pain severity score a statistical significant differences were found at 6 and 12 h with p-values of 0.039 and 0.024 respectively while there was no statically significant difference in incidence of postoperative nausea vomiting (p = 0.448). ConclusionAdministration of 8 mg intravenous dexamethasone to fascia iliaca compartment block increases time to first analgesic request, decrease total 24 h analgesic consumption. Trial registration numberPACTR201910904223565.

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

BackgroundEpidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.MethodsSixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.ResultThe 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group.ConclusionThe repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.Trial registrationClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

Ultrasound Guided Oblique Subcostal Transverse Abdominis Plane Block using Local Anaesthetic Versus Saline for Laparoscopic Cholecystectomies: A Randomised Controlled Trial

Introduction: Laparoscopic cholecystectomy surgery causes patients to have postoperative discomfort due to pain caused by incisions on the anterior abdominal wall. With the introduction of peripheral nerve blocks, the dosage of systemic analgesics can be significantly reduced and thereby the side-effects that may be caused by them. Oblique Subcostal Transversus Abdominis Plane (OSTAP block) which is a variant of the TAP block provides superior analgesia for supraumbilical procedures. Aim: To compare the efficacy of ultrasound-guided OSTAP block using 0.35% ropivacaine with saline OSTAP block in patients undergoing elective Laparoscopic cholecystectomy surgery. Materials and Methods: Forty-two ASA 1 and 2 patients posted for elective laparoscopic cholecystectomies were randomly assigned into two groups. Group A received bilateral OSTAP block with 0.35% ropivacaine and Group B received bilateral OSTAP block with sterile normal saline after the induction of general anaesthesia. Intraoperatively, the dose of opioid required during surgery and postoperatively pain score, opioid consumption, Postoperative Nausea and Vomiting (PONV) and Post Anaesthesia Care Unit (PACU) length of stay were evaluated. For all statistical evaluations, a two-tailed probability p-value of <0.05 was considered significant. Results: Intraoperative opioid consumption was higher in Group B but was statistically insignificant with a p-value of 0.575. Opioid consumption during the first eight hours after surgery and within 24 hours was also lower in Group A. When considering the quality of postoperative analgesia, Group A showed a significantly lower VAS score than Group B immediately after surgery, 30 minutes, 2 hours, 4 hours, 6 hours and 24 hour postoperatively. PACU stay in Group A was significantly less (p<0.001) with nearly all patients reaching discharge criteria within 30 minutes of reaching the PACU. There was no significant difference in the incidence of postoperative nausea vomiting in the groups. Conclusion: OSTAP block with 0.35% ropivacaine provided adequate analgesia with opioid-sparing effect in the postoperative period after a laparoscopic cholecystectomy

Evaluation of transversus abdominis plane block for renal transplant recipients - A meta-analysis and trial sequential analysis of published studies.

Background:Patients undergoing renal transplant (RT) have altered drug/opioid pharmacokinetics. Transversus abdominis plane (TAP) block in renal transplant recipients has been recently evaluated for analgesic and opioid-sparing potential by many trials.Methodology:The studies comparing TAP-block to conventional analgesic regimens for RT were searched. Comparisons were made for total opioids consumed (as morphine-equivalents) during the first postoperative 24-h (primary objective), intraoperative, and immediate-postoperative period. Pain scores and postoperative nausea-vomiting (PONV) were also evaluated. Trial sequential analysis (TSA) was used to quantify the strength of analysis.Results:Ten-trials with 258 and 237 patients in control and TAP-block group, respectively, were included. TAP-block decreased the 24-h (reported in 9-trials) opioid consumption by 14.61 ± 4.34 mg (reduction by 42.7%, random-effects, P < 0.001, I2 = 97.82%). Sample size of the present analysis (472) was well past the required “information-size” variable (396) as per the TSA for a power of 85%. Intraoperative opioid consumption also decreased by 2.06 ± 0.63 mg (reduction of 27.8%) (random effects, P < 0.001, I2 = 98.84%). Pain scores with TAP-block were significantly lower in both early and delayed postoperative phase. Odds ratio for PONV without TAP block was 1.99 ± 1.05 (Fixed-effects, P = 0.04, I2 = 0%). Publication bias was likely (Egger's test, X-intercept=7.89, P < 0.05).Conclusions:TAP-block significantly lowers the intraoperative and cumulative postoperative 24-h opioid consumption in RT recipients. Persistent and better pain control is achieved when TAP-Block is used. Benefits of TAP block extend beyond the analgesic actions alone as it also decreases the 24-h incidence of postoperative nausea vomiting as well. The technique of the block needs standardization for RT recipients.