Incidence Of Postoperative Nausea Research Articles

Gastric Negative Pressure Suction Method Reduces the Incidence of PONV after Orthognathic Surgery.

ObjectiveTo investigate the effect of gastric negative pressure suction on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing orthognathic surgery.MethodsA retrospective study of 772 patients who underwent orthognathic surgery from October 2016 to January 2021 was performed, excluding possible confounding factors. The patients were divided into a negative gastric suction group (group 1) and a group without gastric suction (group 2), according to whether gastric suction was used after general anaesthesia. There were 386 patients in each group. The incidence of PONV was compared between the two groups.ResultsThe incidence of PONV was 29% in the negative gastric suction group and 58.8% in the non-gastric suction group. The incidence of PONV in the gastric negative pressure suction group was significantly lower than that in the non-gastric negative pressure suction group, and the difference was statistically significant (p < 0.05).ConclusionBy reducing the risk of perioperative bleeding in orthognathic surgery, gastric negative pressure aspiration can reduce the incidence and operation time of PONV after orthognathic surgery.

Efficacy and safety of sugammadex for neuromuscular blockade reversal in pediatric patients: an updated meta-analysis of randomized controlled trials with trial sequential analysis

BackgroundA recent survey revealed that extensive off-label use of sugammadex in pediatric anesthesia deserved particular attention. The present study with trial sequential analysis (TSA) aimed to evaluate the effects of sugammadex for antagonizing neuromuscular blockade (NMB) in pediatric patients, and to investigate whether the findings achieved the required information size to draw conclusions.MethodsPubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched from inception to April 2021. All randomized controlled trials used sugammadex as reversal agent in pediatric patients were enrolled. Time from NMB reversal to recovery of the train-of-four ratio (TOFr) to 0.9 and extubation time were considered as co-primary outcomes, and incidences of adverse events were considered as secondary outcomes. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to rate the quality of evidences.ResultsData from 18 studies involving 1,065 pediatric patients were acquired. The results revealed that use of sugammadex was associated with shorter duration from administration of reversal agents to TOFr > 0.9 (MD = -14.42, with 95% CI [-17.08, -11.75]) and shorter interval from reversal from NMB to extubation (MD = -13.98, with 95% CI [-16.70, -11.26]) compared to control groups. TSA also indicated that the current sample sizes were sufficient with unnecessary further trials. Analysis of secondary outcomes indicated that administration of sugammadex was associated with less incidence of postoperative nausea and vomiting (PONV), bradycardia, and dry mouth compared to control groups.ConclusionConsidering of satisfactory and rapid neuromuscular blockade reversal with low incidences of adverse events, sugammadex might be considered as the preferred option for children in clinical anesthesia practice compared to acetylcholinesterase inhibitors. However, overall low-quality evidences in present study rated by GRADE system indicated that superiority of sugammadex employed in pediatric patients needs to be confirmed by more studies with high quality and large sample size in future.

A comparative study between ultrasound-guided serratus anterior plane block and conventional IV analgesics for post-operative pain management in modified radical mastectomy

BackgroundSurgery is the first line of treatment for early, localized, or operable breast cancer and it is associated with severe post-operative pain. Although opioids have been the mainstay for managing post-operative pain, they have undesirable side effects. A variety of methods, including thoracic epidural, paravertebral, and intercostal blocks have been used to manage breast surgery pain; however, each of these blocks has some drawbacks. Serratus anterior plane block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. This study compares between the effect of serratus anterior plane block and conventional IV analgesia on post-operative pain after modified radical mastectomy.ResultsPost-operative pain scores were significantly lower in the SAPB group in the first 8 h compared to the control group (P < 0.05), the time to the first rescue analgesic was significantly longer in the SAPB group with a mean 354 min compared to the control group; the mean is 17.8 min, the total dose of rescue analgesic was significantly lower in the SAPB group with a mean 50 mg in the first 24 h compared to a mean of 212.5 mg in the control group. The patient’s satisfaction scores were higher, the incidence of post-operative nausea and vomiting was significantly lower among the SAPB group compared to the control group. No other complications were recorded in either group.ConclusionsThe serratus anterior plane block can be used as one of the modalities in managing the pain of patients undergoing MRM surgery. This procedure was effective in reducing the need for post-operative opioids usage, better patient satisfaction with fewer side effects as post-operative nausea and vomiting. It is simple and easy-to-learn technique.

Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial.

IntroductionThe aim of this study is to observe the effect of spinal anesthesia (SA) and ultrasound-guided caudal epidural blocks (CEB) on perioperative satisfaction in patients undergoing anorectal surgery.MethodsA group of 106 patients were randomly allocated to receive either SA (the SA group) or CEB (the CEB group), and 11 patients were excluded. Finally, 95 patients were left, with 48 in the SA group and 47 in the CEB group for data analysis. The primary endpoint was patient satisfaction with the quality of their anesthetic technique. The secondary outcome measures included postoperative pain at 2, 4, 8, 16, 24, and 48 h after surgery at rest, time to first analgesic request, analgesia requirements, incidence of phantom limb syndrome (PLS), time until return of bowel function, time to ambulation, incidence of postoperative nausea and vomiting (PONV), intraoperative mean arterial pressure (MAP) reduction > 20% from baseline, and surgeon satisfaction.ResultsA significantly lower proportion of patients in the SA group was highly satisfied with the quality of their anesthetic technique compared with the CEB group (20.8% versus 68.1%). NRS scores at rest were significantly lower at 4, 8, 16, and 24 h after surgery in the CEB group compared with the SA group. The time to first analgesic request was significantly earlier for patients in the SA group compared with patients in the CEB group. Analgesia requirements, the incidence of PLS, the incidence of PONV, and intraoperative MAP reduction > 20% from baseline were significantly decreased in the CEB group. There were no significant differences between the groups in time until return of bowel function, surgeon satisfaction, or time to ambulation.ConclusionsUltrasound-guided caudal epidural blocks have higher patient satisfaction compared with spinal anesthesia.Trial RegistrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR 2000041026) on 06/12/2020.

Dexamethasone Attenuates the Perioperative Acute Phase Response for Simultaneous Bilateral Total Hip Arthroplasty.

This study aimed to evaluate the effect of perioperative dexamethasone on acute phase response (APR) after simultaneous bilateral total hip arthroplasty (SimBTHA). A retrospective case-control study was performed on 177 SimBTHA procedures. The patients were divided into 2 cohorts: patients receiving perioperative dexamethasone and patients in whom no dexamethasone was administered. We observed the effects of perioperative dexamethasone on the APR following SimBTHA by trending C-reactive protein and interleukin-6. Besides, the incidence of postoperative nausea and vomiting (PONV), postoperative visual analog scale (VAS) score, use of antiemetic and analgesic rescue, and complications were also compared. Compared to the no dexamethasone group, patients receiving dexamethasone yielded a significantly decreased C-reactive protein on postoperative days 1, 2 and 3. Such differences of interleukin-6 were also detected. In addition, the incidence of PONV, postoperative VAS score, and use of antiemetic and analgesic rescue were significantly decreased without increasing the risk of early surgical wound infection and gastrointestinal hemorrhage in patients receiving dexamethasone. The anti-inflammatory effects of dexamethasone can attenuate the APR after SimBTHA as well as decrease the PONV, postoperative VAS score, and use of antiemetic and analgesic rescue.

Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial

Background Quadratus lumborum block (QLB) has been used to reduce postoperative acute pain and opioid consumption. However, the efficacy of QLB on the quality of recovery (QoR) after gastrointestinal surgery has not been established. The aim of this study was to evaluate the ability of QLB to enhance the postoperative QoR in patients undergoing open gastrointestinal surgery. Methods Eighty-four patients undergoing open gastrointestinal surgery were randomized to receive ultrasound-guided QLB with either 20 ml of 0.375% ropivacaine or saline. The primary outcome was the QoR-15 score at 24 h after surgery. The secondary outcomes were the postoperative pain intensity, opioid consumption, the incidence of nausea, vomiting, and chronic pain. Results The global QoR-15 score at 24 h postoperatively was significantly higher in the QLB group than in the control group (mean difference: 16.9; 95% CI: 11.9–21.9). Additionally, the QoR-15 scores for five dimensions were significantly higher in the QLB group than in the control group. The cumulative oxycodone consumption was significantly lower in the QLB group during 0–6, 6–24, 0–24, 24–48, and 0–48 h postoperatively than in the control group. At rest or during coughing, the pain verbal rating scale scores were significantly lower at 1, 3, 6, 12, and 24 h after surgery in the QLB group than in the control group. The incidence of postoperative nausea was significantly different between the groups, but postoperative vomiting was not. Conclusion Single-injection posteromedial QLB with ropivacaine enhanced the QoR at 48 h after surgery and improved analgesia during the early postoperative period in patients undergoing gastrointestinal surgery.

Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy.

BackgroundDespite all of the benefits provided by laparoscopic cholecystectomy, such as rapid recovery and shorter hospital stay for patients, the incidence of postoperative nausea and vomiting (PONV) and postoperative pain (POP) still remains high.ObjectivesThis study was designed to compare the effects of intraperitoneal (IP) and intravenous (IV) dexamethasone on the reduction of PONV and POP.MethodsThis prospective, randomized, double-blind clinical trial was conducted on a study population of 86 adult patients who were scheduled for laparoscopic cholecystectomy with the American Society of Anesthesiologists class I-II. The patients were randomized into three groups, namely IP dexamethasone (n = 29), IV dexamethasone (n = 29), and control (n = 28) groups. The patients were followed for clinical outcomes, including PONV, POP, and consumption of antiemetics, and their hemodynamic status during the first 24 hours after the surgery.ResultsIn the first 24 hours after the operation, no significant differences were observed in nausea (P = 0.41) and vomiting (P = 0.38) between the IP and IV dexamethasone groups. However, there was a lower severity of nausea in the IP group (P = 0.001). Additionally, the visual analog scale score representing POP was significantly reduced in the IP group (P = 0.02). No significant differences in the hemodynamic status were observed after the operation between all the three groups.ConclusionsThe administration of 8 mg IP dexamethasone was associated with significantly reduced pain and severity of nausea, but not PONV, after laparoscopic cholecystectomy.

Analgesic effects of sufentanil in combination with flurbiprofen axetil and dexmedetomidine after open gastrointestinal tumor surgery: a retrospective study

BackgroundTo investigated the effects of sufentanil in combination with flurbiprofen axetil and dexmedetomidine for patient-controlled intravenous analgesia (PCIA) on patients after open gastrointestinal tumor surgery, and compared this combination with traditional PCIA with pure opioids or epidural analgesia (PCEA).MethodsPatients (n = 640) who underwent open gastrointestinal tumor surgery and received patient-controlled analgesia (PCA) were included. According to the type of PCA, patients were assigned to three groups: MPCIA (PCIA with sufentanil, flurbiprofen axetil, dexmedetomidine and metoclopramide), OPCIA (PCIA with sufentanil, tramadol and metoclopramide) and PCEA group (PCEA with sufentanil and ropivacaine). The characteristics of patients, intraoperative use of analgesics, postoperative visual analogue scale (VAS), postoperative adverse reactions and postoperative recovery were collected. The primary outcome was postoperative VAS score. One-way ANOVA, Kruskal-Wallis H test, Fisher exact probability method, and binary logistic regression analysis were used for analysis.ResultsThere were no significant differences in the characteristics of patients, operation time, tumor site and the use of postoperative rescue analgesics among the groups. In the first two days after open gastrointestinal tumor surgery, the VAS (expressed by median and interquartile range) of MPCIA (24th h, resting: 1,1; movement: 3,2. 48th h, resting: 0,1; movement: 2,1.) and PCEA (24th h, resting: 0,1; movement: 2,1. 48th h, resting: 0,1; movement: 2,2.) groups were significantly lower than those of OPCIA group (24th h, resting: 2.5,2; movement: 4,2. 48th h, resting: 1.5,1.75; movement: 3,1.) (all p < 0.01). The incidence of postoperative nausea and vomiting in MPCIA group was 13.6% on the first day after surgery, which was significantly higher than that in PCEA group. There was no significant difference in the incidence of other postoperative adverse events. Higher intraoperative sufentanil dosage (OR (95%CI) = 1.017 (1.002–1.031), p = 0.021), lower body mass index (OR (95%CI) = 2.081 (1.059–4.089), p = 0.033), and tumor location above duodenum (OR (95%CI) = 2.280 (1.445–3.596), p < 0.001) were associated with poor postoperative analgesia.ConclusionsThe analgesic effects of PCIA with sufentanil in combination with flurbiprofen axetil and dexmedetomidine on postoperative analgesia was better than that of traditional pure opioids PCIA, and similar with that of PCEA.

Association between intraoperative end-tidal carbon dioxide and postoperative nausea and vomiting in gynecologic laparoscopic surgery

Gynecologic laparoscopic surgery has a high incidence of postoperative nausea and vomiting (PONV). Studies suggest that low intraoperative end-tidal carbon dioxide (EtCO2) is associated with an increased incidence of PONV, but the results have not been consistent among studies. This study investigated the association between intraoperative EtCO2 and PONV in patients undergoing gynecologic laparoscopic surgeries under general anesthesia. This retrospective cohort study involved patients who underwent gynecologic laparoscopic surgeries under general anesthesia at Kyoto University Hospital. We defined low EtCO2 as a mean EtCO2 of < 35 mmHg. Multivariable modified Poisson regression analysis examined the association between low EtCO2 and PONV during postoperative two days and the postoperative length of hospital stay (PLOS). Of the 739 patients, 120 (16%) had low EtCO2, and 430 (58%) developed PONV during postoperative two days. There was no substantial association between low EtCO2 and increased incidence of PONV (adjusted risk ratio: 0.96; 95% confidence interval [CI] 0.80–1.14; p = 0.658). Furthermore, there was no substantial association between low EtCO2 and prolonged PLOS (adjusted difference in PLOS: 0.13; 95% CI − 1.00 to 1.28; p = 0.816). Intraoperative low EtCO2, specifically a mean intraoperative EtCO2 below 35 mmHg, was not substantially associated with either increased incidence of PONV or prolonged PLOS.

Incidence of Hypotension, Bradycardia, and Post-operative Nausea and Vomiting with Spinal Anesthesia in Cesarean Section Patient

Background. Cesarean section is performed through an open abdominal incision (laparotomy) and an incision through the uterus (hysterotomy). Generally, cesarean section is performed with regional anesthesia techniques, with spinal anesthesia being the primary choice. Complications that often occur after the administration of spinal anesthesia include hypotension, bradycardia, and postoperative nausea and vomiting. The aim of this study was thus to identify the incidence of hypotension, bradycardia, and postoperative nausea and vomiting caused by spinal anesthesia during cesarean section procedures.&#x0D; Methods. This was a cross-sectional study with a descriptive, quantitative design. Data were obtained from the medical records of patients undergoing cesarean section procedures. Univariate analysis was performed to analyze data using IBM SPSS software version 28.&#x0D; Results. Univariate results showed that of the 297 samples, the incidence of hypotension based on mean arterial pressure was 1.7%, the incidence of bradycardia was 0.7%, and the incidence of postoperative nausea and vomiting was 3%.&#x0D; Conclusions. There was a 1.7% incidence of hypotension in patients undergoing cesarean section after spinal anesthesia, with 98.3% not experiencing hypotension. The incidence of bradycardia was 0.7% in cesarean section patients after spinal anesthesia, with 99.3% not experiencing bradycardia. The incidence of postoperative nausea and vomiting was 3% in cesarean section patients after spinal anesthesia, with 97% not experiencing postoperative nausea and vomiting.

Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery

Objective: To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting (PONV) in patients scheduled for laparoscopic surgery. Methods: A total of 86 female patients were prospectively administered dexmedetomidine 1 μg/kg i.v. (the group A, n=43), and dexamethasone 8 mg i.v. (the group B, n=43). The two groups were compared in treatment response, hemodynamic changes, and Numerical Analog Scale (NAS). Besides, the relation of PONV with patient baseline characteristics in the perioperative period was determined as well. Results: Patients in group A had lower PONV scores (t=3.1, P&lt;0.002), less needs for rescue anti-emetics (χ2=0.47, P&lt;0.001), and decreased intraoperative heart rate (t=9.72, P&lt;0.001) and mean arterial pressure (t=7.58, P&lt;0.001) compared to that of group B. Group A reported lower NAS than group B (t=2.66, P&lt;0.001). In addition, we found no relationship between PONV score and rescue anti-emetic requirement, age, or body mass index (P=0.96, P=0.60, P=0.28, respectively). Conclusion: Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries, with better efficacy than dexamethasone. Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia.

The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

The role of lidocaine in perioperative pain and recovery management

Pain control is crucial in surgical patients, being an essential part of enhanced recovery after surgery protocols. Lidocaine, an amide local anesthetic, was primarily used as an antiarrhythmic. It has analgesic, antihyperalgesic and anti-inflammatory effects, with various actions on cardiovascular, respiratory, and digestive systems. Lidocaine has been shown to also have antithrombotic, antimicrobial, and antitumoral effects. Numerous studies have reported its safe profile and role in managing perioperative pain after breast cancer, abdominal, genitourinary, gynecologic, obstetric, orthopedic, cardiothoracic, spine, thyroid, and upper airway surgery. Lidocaine, as part of multimodal analgesia, also shows promising results in ambulatory surgery. Therefore, the use of intravenous lidocaine in the perioperative period is mainly associated with better pain control, reduced opioid use, diminished incidence of postoperative nausea, vomiting, and ileus, and exhibits antithrombotic effects.

Opioid-Sparing Analgesia Impacts the Perioperative Anesthetic Management in Major Abdominal Surgery.

Background and Objectives: The management of acute postoperative pain (APP) following major abdominal surgery implies various analgetic strategies. Opioids lie at the core of every analgesia protocol, despite their side effect profile. To limit patients’ exposure to opioids, considerable effort has been made to define new opioid-sparing anesthesia techniques relying on multimodal analgesia. Our study aims to investigate the role of adjuvant multimodal analgesic agents, such as ketamine, lidocaine, and epidural analgesia in perioperative pain control, the incidence of postoperative cognitive dysfunction (POCD), and the incidence of postoperative nausea and vomiting (PONV) after major abdominal surgery. Materials and Methods: This is a clinical, observational, randomized, monocentric study, in which 80 patients were enrolled and divided into three groups: Standard group, C (n = 32), where patients received perioperative opioids combined with a fixed regimen of metamizole/acetaminophen for pain control; co-analgetic group, Co-A (n = 26), where, in addition to standard therapy, patients received perioperative systemic ketamine and lidocaine; and the epidural group, EA (n = 22), which included patients that received standard perioperative analgetic therapy combined with epidural analgesia. We considered the primary outcome, the postoperative pain intensity, assessed by the visual analogue scale (VAS) at 1 h, 6 h, and 12 h postoperatively. The secondary outcomes were the total intraoperative fentanyl dose, total postoperative morphine dose, maximal intraoperative sevoflurane concentration, confusion assessment method for intensive care units score (CAM-ICU) at 1 h, 6 h, and 12 h postoperatively, and the postoperative dose of ondansetron as a marker for postoperative nausea and vomiting (PONV) severity. Results: We observed a significant decrease in VAS score, as the primary outcome, for both multimodal analgesic regimens, as compared to the control. Moreover, the intraoperative fentanyl and postoperative morphine doses were, consequently, reduced. The maximal sevoflurane concentration and POCD were reduced by EA. No differences were observed between groups concerning PONV severity. Conclusions: Multimodal analgesia concepts should be individualized based on the patient’s needs and consent. Efforts should be made to develop strategies that can aid in the reduction of opioid use in a perioperative setting and improve the standard of care.

Incidence of Postoperative Nausea and Vomiting after Thoracoscopic Lung Surgery：Comparison between Patient-Controlled Epidural Analgesia and Intravenous Patient-Controlled Analgesia

Incidence of Postoperative Nausea and Vomiting after Thoracoscopic Lung Surgery：Comparison between Patient-Controlled Epidural Analgesia and Intravenous Patient-Controlled Analgesia

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy

BackgroundUltrasound (US)-guided quadratus lumborum block (QLB) and transversus abdominis plane block (TAP) are used as a part of multimodal analgesia for postoperative pain after abdominal procedures, as they improve postoperative pain.ResultsQLB group showed significantly better visual analog score (VAS) scores from 6 h till 24 h postoperative. Time for the first request for pethidine was significantly longer in the QLB group (398.3 ± 23.7 min) than in the TAP group (80.3 ± 20.7 min), (p < 0.0001 and its total consumption was significantly lesser (p = 0.007) in the QLB group (68.33 ± 66.28) than in TAP group (120.0 ± 76.11). Also, the sensory level was higher in the QLB group (8.3 ± 0.63 segments) than in the TAP group (6.2 ± 0.79 segments), (p < 0.001). Moreover, only 2 patients (6.67%) in the QLB group experienced nausea and/or vomiting versus 9 (30%) in TAP group with significant value.ConclusionsQLB was more effective in providing visceral and somatic pain analgesia after total abdominal hysterectomy (TAH) in comparison to TAP block, QLB resulted in wider sensory blockade compared to TAP block with less incidence of postoperative nausea and/or vomiting.

Implementation of an enhanced recovery after surgery program in the treatment of uterine fibroids with focused ultrasound ablation surgery

Background Enhanced recovery after surgery (ERAS) can reduce the length of hospital stay, incidence of surgery-related complications, and postoperative pain. We aimed to demonstrate the implementation of an ERAS pathway in the treatment of uterine fibroids with focused ultrasound ablation surgery (FUAS). Materials and Methods A retrospective data analysis was performed on clinical outcomes encompassing the following three phases: before ERAS (pre-ERAS), during adjustment of ERAS (interim-ERAS), and after the introduction of an ERAS program (post-ERAS). The purpose of describing the interim-ERAS was to provide references for the formulation of the program during the course of FUAS by describing the adjustment processes. Data from patients admitted to the hospital from September 2019 to December 2019 and April 2020 to November 2020 and who met the criteria for FUAS in the treatment of their uterine fibroids were examined. Length of stay, cost of surgery, postoperative pain score, utilization of postoperative analgesics, and incidence of postoperative adverse events were compared across the abovementioned three phases. Results Compared with the pre-phase, the cost of treatment and length of stay were reduced after the implementation of ERAS. The use of analgesics before leaving the operating room, as well as the incidence of postoperative nausea and vomiting, were also reduced. Conclusion The implementation of an ERAS protocol might benefit patients with uterine fibroids treated with FUAS in terms of requiring a shorter hospitalization period, lower costs, and reduced opioid use.

Abstract No.: ABS0807 : Effects of intravenous Lignocaine infusion on Sevoflurane consumption in inhalation maintained anaesthesia by monitoring entropy: A randomised controlled study

Background & Aims:The present study aimed to study the effect of intravenous Lignocaine infusion on Sevoflurane consumption required to maintain entropy between40 and 60 during anesthesia maintenance in humans. Pain scores using Numeric rating score (NRS) scale and incidence of post-operative nausea and vomiting were assessed postoperatively.Methods:The present study included 52 patients of either sex, of American Society of Anesthesiologists (ASA) grade I and II; aged between 18-70 years undergoing surgeries of >2 hours under general anaesthesia. Patients were randomly allocated into two groups using computer generated random number table into Lignocaine group, where lignocaine infusion was used and Control group, where equal volume of saline was infused. Anaesthesia regimens in both groups were standardised. Patient’s haemodynamics were monitored. Intraoperative Sevoflurane consumption (Value obtained from GE Avance CS2 machine) was noted at the end of surgery. Pain scores using NRS scale and postoperative nausea and vomiting incidence were assessed postoperatively.GroupMean±SD P PLSFAge49.62±14.554.7±11.380.19Bloodloss553.33±333.2545±466.160.937MAP185.9±16.5585.87±16.460.994HR 172.97±17.0772.23±12.020.848MAP3081.7±9.8585.27±16.870.322HR 3071.53±12.0268.47±13.090.348MAP6081.63±10.8188.07±12.470.037HR6071.1±13.0369.83±11.910.696MAP9081.07±14.7786.23±12.070.143HR9072.6±14.7170.1±13.230.492MAP12079.1±11.2185.87±10.830.021HR12070.83±15.4668.8±11.990.571MAP15079.93±9.0583.87±14.850.22HR15072±17.0470.63±13.810.734MAP18083.1±9.482.93±13.520.956HR18074.07±14.5272.83±12.390.725MAP21079.88±9.1985.21±150.144HR21076.25±16.2573±11.510.428MAP24085.41±14.0483.75±14.530.74HR24070.82±18.0377.56±15.980.266MAP27079.47±12.8183.4±14.030.486HR27071.93±16.8873.8±12.440.753MAP30079.1±15.5780.83±11.030.799HR30074.9±22.7278.33±14.990.722MAP33081.86±11.6474±5.230.16HR33076.14±21.2176.75±10.90.951MAP36078.33±9.8770±00.541HR36064±380±00.044ABG1pH7.38±0.057.37±0.030.578ABG2pH7.36±0.057.34±0.060.085@1pCo239.39±4.2439.63±5.310.852@2pCo240.18±4.2641.86±7.170.275@1pO2175.86±63.03178.67±68.030.869@2pO2204.57±43.82188.1±48.910.175@1Na134±4.11135.8±4.110.095@2Na135.07±2.42136.1±40.232@1K3.74±0.333.77±0.410.758@2K3.82±0.343.94±0.570.326@1Ca1.14±0.151.15±0.170.294@2Ca1.03±0.11.14±0.06<0.001@1Cl107.71±4.8109.27±3.150.155@2Cl107.17±3.68109.9±3.720.006@1Hb11.23±1.7110.82±2.290.431@2Hb10.17±1.7110.07±2.080.834@1glu132.48±42.14142.96±39.770.373@2glu157.23±38.88159.36±32.710.838@1HCo323.23±2.4522.64±3.350.463@2HCo322.33±3.0221.49±2.720.28@1BE-1.56±2.87-1.71±2.870.857@2BE-2.53±3.31-3.08±2.010.481Results:There was a statistically significant difference in hourly Sevoflurane consumption with reduced hourly consumption inLignocaine group, (P=0.03). There was no statistically significant difference in the total amount of sevoflurane consumption between the two groups, (p=0.52). The lignocaine group had lower pain score than control group 45min post extubation(P=0.04) and 1 day post surgery (P=0.01), with no significant difference in the incidence of post-operative nausea and vomiting.VariablesLignocaine GroupControl Group P Mean Sevoflurane Consumption (Per Hour) ml n(Per Hour) ml14±316±50.03Conclusion:Perioperative lignocaine infusion significantly reduces hourly Sevoflurane consumption in inhalation maintained anaesthesia. Perioperative lignocaine infusion causes significant reduction in pain scores but no difference in incidence of PONV. Lignocaine infusion is safe and further studies may provide a strong evidence for routine use of perioperative lignocaine.

Effect of Preoperative Administration of Oral Melatonin on Pneumatic Tourniquet-Induced Ischemia-Reperfusion Injury in Orthopedic Surgery of Lower Extremities: A Randomized Clinical Trial.

Background: Ischemic reperfusion injury (IRI) causes cellular damage and dysfunction. The present study aimed to evaluate the effect of melatonin on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower extremities.Methods: A randomized clinical trial was conducted at Chamran Hospital, Shiraz University of Medical Sciences (Shiraz, Iran), from September to November 2019. The target population was patients scheduled for elective orthopedic surgery of the lower extremities. A total of 67 patients were randomly divided into two groups, placebo (n=34) and melatonin (n=33). The groups received 10 mg melatonin or placebo the night before surgery and two hours before surgery. Primary outcome variables were the serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Hemodynamic parameters, sedation score, and drug side effects were also evaluated. Data were analyzed using SPSS version 21.0 software. P<0.05 was considered statistically significant.Results: In the analysis phase, due to loss to follow-up (n=26), 41 patients divided into two groups of melatonin (n=20) and placebo (n=21) were evaluated. There was no significant difference in demographic data, duration of surgery (P=0.929), and tourniquet time (P=0.496) between the groups. The serum levels of SOD and MDA were not significantly different between the groups (P=0.866 and P=0.422, respectively), nor were the incidence of postoperative nausea (P=0.588) and patients’ satisfaction (P=0.088). However, the postoperative sedation score and vomiting between the groups were significantly different (P<0.001).Conclusion: Administration of 10 mg melatonin provided effective sedation, but had no significant effect on the serum levels of SOD and MDA, nor on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower limbs.Trial registration number: IRCT20141009019470N87.

Preoperative electroacupuncture for postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial.

We aimed to evaluate the effectiveness and safety of preoperative electroacupuncture (EA) on the incidence of postoperative nausea and vomiting (PONV), and severity of postoperative pain, in gynecological patients undergoing laparoscopic surgery. The effects of EA administered at different preoperative time points were compared. A total of 413 patients undergoing elective laparoscopic gynecological surgery were randomly allocated into 4 groups receiving EA the day before surgery (Group Pre, n = 103), 30 min before (Group 30, n = 104) or both (Group Comb, n = 103), or usual care alone (Group Usual, n = 103). All acupuncture groups had usual care. The incidence of PONV and pain at 24 h were primary outcomes. Secondary outcomes included the severity of postoperative nausea, vomiting and pain, requirement for antiemetic medication and quality of recovery (QoR)-15 scores after surgery. There were significant differences between the four groups in nausea and vomiting incidence (0-24 h), postoperative antiemetic use (0-48 h), and postoperative pain (0-6 h), with the EA groups recording the lowest levels. Regarding primary outcomes, incidence of nausea and vomiting at 6-24 h was 28/11/18/11% (p = 0.003) 23/5/8/9% (p < 0.001), respectively, for Groups Usual/Pre/30/Comb. Accordingly, EA reduced the incidence of nausea and vomiting at 6-24 h by 61/34/60% and 79/65/61% for Groups Pre/30/Comb, respectively. Regarding secondary outcomes, incidence of nausea and vomiting at 0-6 h was 20/9/11/7% (p = 0.013) and 17/7/9/6% (p = 0.021), respectively, for Groups Usual/Pre/30/Comb. Rescue antiemetics at 0-6 h were required by 18/4/11/4% (p = 0.001) in Groups Usual/Pre/30/Comb. The mean numerical rating scale (NRS) pain score (0-10) at 0-6 h was significantly different between groups (2.45/1.89/2.01/1.97 for Groups Usual/Pre/30/Comb, p = 0.024). There were no significant differences between the three EA-treated groups. In gynecological patients undergoing laparoscopic surgery and treated with multimodal antiemetic methods, one session of preoperative EA may be a safe adjunctive treatment for PONV prophylaxis. Optimal timing of EA requires further verification. ChiCTR-INR-16010035 (Chinese Clinical Trial Registry).