Incidence Of Postoperative Nausea And Vomiting In Group Research Articles

Efficacy of Intravenous Glucose for Preventing Postoperative Nausea and Vomiting after Abdominal Hysterectomy under General Anesthesia

Objective: This study aimed to evaluate the ability of intravenous glucose administration during the maintenance of anesthesia as an alternative method for diminishing the incidence of postoperative nausea and vomiting (PONV) in patients undergoing total abdominal hysterectomy (TAH).Material and Methods: This was a prospective, double-blind randomized placebo-controlled trial. One hundred and ten patients who were 18 - 65 years old, American Society of Anesthesiology (ASA) 1 or 2 and required general anesthesia for TAH, were divided randomly to receive 5% DNSS (Group D) or normal saline (Group N) as a maintenance fluid at a rate of 2 mL/kg/hr. The primary outcome was the incidence of PONV at the arrival time in post-anesthetic care unit (PACU). The secondary outcomes were severity of PONV, time to first dose of an antiemetic drug, amount of antiemetic dose, and length of stay in the hospital.Results: The incidence of PONV in group N was 5.5% and in group D was 10.4% (p-value = 0.360). There were no statistically significant differences regarding the VRS scores, time to the first dose of antiemetic drug, the amount of antiemetic drug, and length of hospital stay between the 2 groups.Conclusions: There was no significant difference in efficacy between intravenous glucose administration and placebo in the prevention of PONV in patients undergoing abdominal hysterectomy under general anesthesia.

A Randomised Blinded Comparison of Epidural Infusion of Ropivacaine, Ropivacaine with Fentanyl for PONV and Sedation in Elective Lower Abdominal Oncosurgeries

Introduction: Epidural analgesia is one of the preferred and convenient mode of perioperative management. Neuraxial opioids augment local anaesthetic effect, thus reducing their requirement for analgesia. The addition of fentanyl may cause side-effects like Postoperative Nausea and Vomiting (PONV), sedation which results in patient discomfort, thus effecting postoperative recovery. Aim: To estimate the incidence, compare the requirement of rescue antiemetics for PONV and Ramsay Sedation Scores within first 24 hours of postoperative period in patients undergoing elective lower abdominal oncological sugeries. Materials and Methods: The present study was a randomised study which was carried out from September 2016 to May 2018, in 70 patients of American Society of Anesthesiologists (ASA) 1 and 2, scheduled for elective lower abdominal oncological surgeries. The study population was divided into group R, comprising of patients receiving epidural infusion of 0.2% ropivacaine and group RF with patients receiving epidural infusion of 0.2% ropivacaine with 2 μg/mL fentanyl. The incidence of PONV, rescue antiemetics for PONV and the incidence of sedation using Ramsay sedation score were evaluated in each group and compared. All data was statistically analysed and compared using Student's t-test, Chi-square. The p-value <0.05 was considered to be statistically significant. Results: Groups were comparable with regard to demographic data. The incidence of PONV in group R was 37.1% and in group RF was 28.6%. The requirement of rescue antiemetic for PONV were comparable in the study groups. However, this was not statistically significant. Patients in group RF had higher mean Ramsay sedation scores at 0, 1, 2, 4, 6, 12, 18 and 24 hours but the observed difference in both the groups was statistically significant p<0.05 except at 0 and 2nd hours which were not statistically significant (p>0.05). Conclusion: This study concludes that the patients receiving epidural infusion of ropivacaine with fentanyl should be given prophylactic antiemetic to minimise patient’s discomfort. Also, these patients when compared to patients receiving epidural infusion of ropivacaine alone require monitoring for sedation during the postoperative period.

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting

Background5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone.MethodsAmong the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups.ResultsThe frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups.ConclusionsThere were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.

Low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement

Objective:To evaluate the effect and safety of low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia(PCEA)in elderly patients undergoing total hip replacement.Methods:A total of 60 elderly patients(ASAⅠ-Ⅱ)undergoing total hip replacement were randomly assigned to two equal groups:Group C was given 0.5 μg/ml sufentanil in 0.15% ropivacaine;Group N was given the same solution with 0.09 μg/(kg·ml)naloxone.The 2 groups were followed up in a double-blinded manner:the visual analogue scale(VAS)for pain score was recorded at 2,6,12,and 24 h to evaluate the analgesia effect.Meanwhile,the incidences of postoperative nausea and vomiting(PONV),pruritus,sedation,respiratory depression,and hypotension were also recorded.Results:The VAS pain score in Group N was significantly lower than that in Group C at 6,12 and 24 h(P0.01).The incidence of PONV in Group N was significantly lower than that in Group C(P0.05);the incidences of other opioid-induced side-effects were not significantly different between the 2 groups.During the course of analgesia,the vital signs of 2 groups were stable;no patients had respiratory depression or hypotension.Conclusion:Low-dose epidural naloxone can enhance the analgesic effect of sufentanil.With timely postoperative monitoring,low-dose naloxone combined with sufentanil and ropivacaine is safe and effective for postoperative patient-controlled epidural analgesia in elderly patients undergoing total hip replacement.

Prophylactic antiemetic effects in gynecologic patients receiving fentanyl IV-patient controlled analgesia: comparison of combined treatment with ondansetron and dexamethasone with metoclopramide and dexamethasone

BackgroundThis study was conducted to compare the efficacy of a combination of ondansetron and dexamethasone with that of metoclopramide and dexamethasone for prevention of postoperative nausea and vomiting (PONV) in gynecologic patients receiving fentanyl IV-patient controlled analgesia.MethodsOne hundred patients were divided into two groups at random. In Group O, 5 mg of dexamethsone was administered after tracheal intubation, while 4 mg of ondansetron was administered at the end of surgery. In Group M, 5 mg of dexamethsone was administered after tracheal intubation and 20 mg metoclopromide was administered at the end of surgery. During the experiment, the PONV was evaluated at regular intervals. In addition, the incidence of nausea, and vomiting and the numerical rating scale (NRS) of nausea was measured (range, 0-10).ResultsThe overall incidence of PONV in Group O was 22/50 (44%) while that in Group M was 19/50 (38%). There were no significant differences in the incidence of nausea, moderate to severe nausea (NRS of nausea, 4-10), or vomiting between groups.ConclusionsTreatment with a combination of 20 mg metoclopramide and 5 mg dexamethasone is an effective, safe, and inexpensive way to prevent PONV when compared to treatment with 4 mg ondansetron and 5 mg dexamethasone.

The Assessment of Postoperative Nausea and Vomiting (PONV) using Rhodes Index in PONV High Risk Group

Background: The Rhodes index of nausea, vomiting and retching (RINVR) is a reliable and valid instrument to assess PONV. The purpose of this study was to investigate the incidence of PONV in high risk group with using RINVR. Methods: Patients scheduled for elective surgery under general anesthesi a were classified in three groups (group I: two risk factors, group II: three risk factors, group III: four risk factors) by using a simplified risk score. We investigated the incidences of PONV in each group. Results: The incidence of PONV was 12.8% in group I, 25% in group II, and 33.1% in group III, which showed a significant difference between group I and group II, between group I and group III. The incidence of PONV, which was over moderate was significantly increased in group III. Conclusions: For patients with three or four risk factors a multimodal antiemetic strategy should be considered. (Korean J Anesthesiol 2008; 54: 278∼82)

Nicotine Patch for the Prevention of Postoperative Nausea and Vomiting

It has been demonstrated that smoking significantly reduces postoperative nausea and vomiting (PONV). However, there are approximately 4000 substances in cigarette smoke that can be responsible for this effect. To demonstrate whether nicotine is the substance with antiemetic effects we applied a nicotine patch in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Seventy-five patients classified as ASA (American Society of Anesthesiologists' classification) I/II were divided in three groups: group 1 (n = 25), which comprised non-smokers; group 2 (n = 25), which comprised patients who had given up smoking for the last 5 years and received perioperatively a nicotine patch that contained 16.6mg nicotine/patch; and group 3 (n = 25), which comprised actual smokers. Postoperatively, the incidence of PONV and the need for antiemetic rescue medication were monitored every 6 hours. We found a significant reduction in the incidence of PONV in group 2 (5/25 [20%], p = 0.0001 vs group 1) and group 3 (8/25 [32%], p = 0.002 vs group 1) compared with group 1 (18/25 [76%]). The difference in incidence of PONV between group 2 and group 3 was not significant (p > 0.05). Nicotine significantly reduced the incidence of PONV after laparoscopic cholecystectomy.

The Effects of Prophylactic Metoclopramide and Induction with Propofol on Postoperative Nausea and Vomiting

Background: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing a laparoscopic cholecystectomy. This study evaluated the effect of prophylactic metoclopramide (MCP) and induction with propofol on PONV. Methods: 165 patients undergoing laparoscopic cholecystectomy were randomly divided into four groups. Groups 1 (control group) and 2 were inducted with thiopental sodium. Groups 3 (propofol group) and 4 were inducted with propofol. Prophylactic metoclopramide 10 mg i.v. was administered in Groups 2 (MCP group) and 4 (propofol + MCP group). The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea severity scores were assessed at 0 to 1 hour and at 1 to 24 hours postoperatively. Results: During the first 24 hours after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 41.5%, 29.3%, 30.3% and 23.3%, respectively. There was no significant difference between the groups. During the period, 1 hour to 24 hours, after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 36.6%, 17.4%, 27.5% and 14.4%, respectively. The incidence of PONV in Group 4 was significantly lower than in Group 1 (P

Effect of Auricular Acupressure Therapy for the Prevention of Postoperative Nausea and Vomiting After Gynecological Surgery

Postoperative nausea and vomiting (PONV) is still a troubling problem in patients who undergo gynecological surgery, especially in patients using morphine for patient-controlled analgesia (PCA). In this study, we investigated whether auricular acupressure therapy reduced the incidence of PONV. A total of 150 female patients (ASA I-II, aged 18-65 years) scheduled to undergo myomectomy or hysterectomy were enrolled in this double-blind, placebo-controlled study and randomly assigned to one of three groups. In groups I and II, we taped seeds of Wangbuliuxing onto auricular points (two sets of four) and asked patients to compress these points four times a day. Group III acted as the control group. Data were available for 124 patients. The incidence of PONV in group I was significantly decreased in the first 2 days (day 1: 16%; day 2: 12%) compared with group II (day 1: 42%, p = 0.021; day 2: 32%, p = 0.048) and group III (day 1: 40%, p = 0.030; day 2: 35%, p = 0.023). Auricular acupressure therapy at the shenmen, jiaogan, wei, and pizhixia points prevented PONV after gynecological surgery with PCA.

A Comparison of the Efficacy and Safety of Tropisetron and Tropisetron Plus Dexamethasone as Antiemetics for Elective Thyroidectomy

Background: Thyroidectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV) ranging from 63% to 84%. In this study, we evaluated the safety and the antiemetic effects of tropisetron 30μg/kg or tropisetron 30μg/kg plus dexamethasone 5 mg in patients undergoing thyroidectomy under a standard anesthetic technique without narcotics. Methods: Sixty-eight patients undergoing thyroidectomy were randomized to receive a placebo (Group C, n = 28), tropisetron 30μg/kg (Group T, n = 23) or tropisetron 30μg/kg plus dexamethasone 5 mg (Group T + D, n = 17) IV over 2-5 minutes immediately before the induction of anesthesia. The effects of these regimens on the development of PONV, adverse events and need for rescue antiemetics were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. Results: In the 0 to 1 hour postoperative periods, the incidence of PONV in group C, T and T + D was 35.7%, 17.4% and 17.6% respectively, which showed no significant difference among the three groups (P > 0.05). In the same period, the incidence of retching or vomiting in Group C, T and T + D was 14.3%, 0% and 0% respectively, which showed a significantly lower incidence in Group T and T + D than Group C (P 0.05). During the first 24 hours postoperatively, the overall incidences of PONV was 67.9% for group C, 60.9% for group T and 58.8% for group T + D, which showed no siginificant difference among the three groups (P > 0.05). Group T + D patients had more headache compared to other groups, but there was no significant difference in the