Incidence Of Postoperative Nausea And Vomiting Research Articles

The effects of two different doses of intravenous dexamethasone on blood glucose concentration intra-operatively and on postoperative pain and emesis in patients undergoing surgery under spinal anesthesia: A double-blind randomized clinical study

Background: Spinal anesthetic techniques are relatively safe and associated with quick and uneventful recovery, but post-operative pain and postoperative nausea and vomiting (PONV) are major concerns after the effect weans off. Steroids by virtue of their anti-inflammatory effect are expected to reduce pain as well as PONV. Aims and Objectives: The study was conducted to evaluate the efficacy of two different doses of intravenous dexamethasone on blood glucose concentration intra-operatively and on post-operative analgesia and emesis for different surgeries under spinal anesthesia. Materials and Methods: This double-blind randomized clinical study was performed on 120 patients aged 20–60 year posted for surgery under spinal anesthesia who were randomly allocated into three groups to receive either normal saline (Group A: 40 pts), intravenous 4 mg dexamethasone (Group B: 40 pts), or iv 8 mg dexamethasone (Group C: 40 pts) immediately after spinal anesthesia. Hemodynamic parameters, respiratory rate, intraoperative blood glucose concentration., severity of post-operative pain, and incidence of PONV was compared among the groups. Results: Patients in Group C had significantly less severe post-operative pain and incidence of PONV (P<0.05). Furthermore, less post-operative rescue analgesia was required in Group C (P<0.05). There was a highly significant rise in intraoperative blood glucose level in Group C as compared to other groups, but it was well below the recommended guidelines (<180 mg/dL). Conclusion: Our study concluded that i.v. dexamethasone 8 mg was more effective, although it caused raised blood glucose concentration intraoperatively, but it also provided prolonged post-operative analgesia, increased time of first rescue analgesic, less incident of post-operative nausea and vomiting, and better patient satisfaction.

EFFICACY OF DEXAMETHASONE ALONE COMPARED TO DEXAMETHASONE AND METOCLOPRAMIDE COMBINED FOR POST-OPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING ABDOMINAL SURGERY

Post-operative nausea and vomiting (PONV) are common complications in patients undergoing major abdominal surgery, with reported frequencies of up to 54% for vomiting and 71% for nausea. PONV, typically within the first 24 hours after surgery, can result in significant morbidity, unexpected hospital admissions, reduced patient comfort, prolonged hospital stays, and increased healthcare costs. The aim of this institutional-based randomized controlled study, conducted at Aziz Bhatti Teaching Hospital in Gujarat from March 2022 to March 2023, was to assess the efficacy of dexamethasone alone and in combination with metoclopramide in preventing post-operative nausea and vomiting in patients undergoing abdominal surgery. One hundred fifty patients aged 18 to 65 who were scheduled for abdominal surgeries were recruited for this study. The patients were randomly assigned to three treatment groups: Group P (placebo), Group D (dexamethasone), and Group DM (dexamethasone and metoclopramide). Data analysis was performed using SPSS version 21, with the one-way ANOVA test used for continuous variables and the Chi-Square test employed for categorical data. A p-value of less than 0.05 was considered statistically significant. The results revealed that the overall incidence of PONV was 62% in the placebo group, 26% in the dexamethasone group, and 14% in the dexamethasone plus metoclopramide group. Significantly fewer patients in the dexamethasone + metoclopramide group (p < 0.05 compared to Group P) and only one patient in the dexamethasone group (p < 0.05 compared to Group P) required rescue antiemetic medication, whereas 8 patients in the placebo group required such treatment. Pain scores, time to first analgesic request, and adverse effects were comparable across all treatment groups. In conclusion, the combination of dexamethasone and metoclopramide demonstrated superior efficacy in preventing PONV compared to dexamethasone alone.

Gravid status is not associated with postoperative nausea and vomiting: a matched case-control study.

Postoperative nausea and vomiting (PONV) is a common and unpleasant complication of general anesthesia. There are well-known risk factors that predispose a patient to develop PONV. While studies exist that explore PONV incidence in gravid and non-gravid women separately, limited studies exist to compare the two cohorts to identify if pregnancy is associated with increased risk for PONV or differences in PONV prophylaxis and treatment. This is a retrospective case-control cohort study, with 1:2 matching based on age, year of surgery, and surgical procedure. Electronic medical records were abstracted for demographic information, predisposing risk factors, prophylactic antiemetics, PONV documentation, rescue antiemetics, PACU stay, and length of hospitalization. Analyses of risk factors for PONV were performed using logistic and multinomial logistic regression analyses. 237 gravid women who underwent non-obstetric procedures with general anesthesia were identified and matched with 474 non-gravid women. PONV complicated the course of 51 (21.5%) gravid and 72 (15.2%) non-gravid women. The number of prophylactic antiemetics was fewer among gravid (median 2 [1, 2]) than non-gravid (3 [2, 3]) women (P < 0.001). No association was found between gravid status and risk for PONV (adjusted odds ratio 1.35 [95%CI 0.84, 2.17], P = 0.222). Gravid women had longer hospital lengths of stay (P < 0.001), despite having shorter surgical duration (P = 0.015). The risk for PONV is similar between gravid and similarly aged women. However, anesthesiologists administer fewer prophylactic antiemetics to gravid women during non-obstetric surgery.

The use of aprepitant for the prevention of postoperative nausea and vomiting in endoscopic transsphenoidal pituitary surgery.

Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear. The purpose of this study was to evaluate the effect of aprepitant in reducing PONV in endoscopic transsphenoidal (TSA) pituitary surgery. A retrospective chart review between July 2021 and January 2023 of 127 consecutive patients who underwent TSA was performed at a tertiary academic institution. Patients were divided into 2 groups based on preoperative aprepitant use. Two groups were matched based on known risk factors of PONV (age, sex, nonsmoking, and history of PONV). The primary outcome was the incidence of PONV. Secondary outcome measures included the number of anti-emetic use, length of stay, and postoperative cererebrospinal fluid (CSF) leak. After matching, 48 patients were included in each group. The aprepitant group demonstrated a significantly lower incidence of vomiting than the non-aprepitant group (2.1%vs 22.9%, p=0.002). The number of nausea episodes and anti-emetic use decreased with aprepitant use (p<0.05). There was no difference in the incidence of nausea, length of stay, or postoperative CSF leak. Multivariate analysis demonstrated that aprepitant decreased the incidence of postoperative vomiting with odds ratio of 0.107. Aprepitant may serve as a useful preoperative treatment to reduce PONV in patients undergoing TSA. Further studies are needed to evaluate its impact in other arenas of endoscopic skull base surgery.

Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery.

To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.

The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial.

Post-operative nausea and vomiting (PONV) is common, undesirable, and stressful following surgery. By focusing attention and resources on those groups of patients most likely to develop PONV, the quality of care provided to the patients can be improved. The primary objective was to compare the incidence of PONV after implementation of the Apfel scoring system with the control group receiving prophylaxis for every surgery. The secondary objective was to identify the effect on the patient's expenditure/savings with respect to management of PONV. This prospective randomized controlled double-blinded study enrolled 70 patients undergoing surgeries under general anesthesia. Patients were randomized to group A (control group - all received PONV prophylaxis) and group B (Apfel stratification performed for PONV prophylaxis). Based on the Apfel system, the risk of PONV was classified as the grades low, moderate, and high risk. Patients at moderate and high risk received PONV prophylaxis in group B. Patients were monitored for PONV during 24 h after surgery and rescue medication given as required. The effect of implementing Apfel risk stratification on the incidence of PONV (primary outcome measure) and on patient expenditure was compared. Compared to administering prophylaxis for all patients, the incidence of PONV [group A-5 patients (14.3%)] did not increase (P = 0.428) after implementing the Apfel scoring system [group B-2 patients (5.7%)]. The number of patients spending on prophylaxis for PONV in group A [35 (100%)] was higher than that in group B [17 (48%)], without increasing expenditure on PONV treatment. Withholding prophylaxis on the basis of the Apfel scoring system did not increase the incidence of PONV compared to providing prophylaxis for all the patients. The overall cost of prevention and treatment of PONV is less when the Apfel scoring system is used.

PERBANDINGAN EFEKTIVITAS KOMBINASI GABAPENTIN-ONDANSETRON DENGAN DEXAMETHASONE-ONDANSETRON SEBAGAI PROFILAKSIS POSTOPERATIVE NAUSEA-VOMITING (PONV) PADA OPERASI LAPAROSKOPI

Background: Post Operative Nausea and Vomiting (PONV) is a complication that most often occurs in patients undergoing surgery under general anesthesia, with an incidence rate of 40-90%. The existing combination drug guidelines to prevent PONV have not been effective in significantly reducing the incidence of PONV. There are several research results that suggest that the GabapentinOndansetron combination is effective in reducing the incidence of PONV.&#x0D; Objective: This study aims to compare the effectiveness of the combination of Gabapentin-Ondansetron with Dexamethasone-Ondansetron as a prophylactic of Post Operative Nausea and Vomiting (PONV) in laparoscopic surgery.&#x0D; Methods: This study is a double-blind Randomized Controlled Trial/RCT involving 78 patients who underwent a laparoscopic procedure. Subjects were divided into two groups A and B. Group A was given a combination of Gabapentin 600 mg and Ondansetron 0.1 mg/kgBW. Group B was given a combination of Dexamethasone 10 mg and Ondansetron 0.1 mg/kgBW. Both groups assessed the incidence of PONV using VNRS for nausea and assessed the presence or absence of vomiting.&#x0D; Results: At 15 and 30 minutes postoperatively, Gabapentin-Ondansetron was better than Dexamethasone-Ondansetron as a prophylactic of nausea (p &lt;0.05) in laparoscopic surgery. At 60, 90, and 24 hours postoperatively, the drug combination of the two groups was as good as nausea prophylaxis (p &gt;0.05) for laparoscopic surgery. Both of these drug combinations had the same effect as vomiting prophylaxis (p &gt;0.05) after laparoscopic surgery.&#x0D; Conclusion: Gabapentin-Ondansetron combination is more effective thanDexamethasone-Ondansetron combination as a prophylactic of Post OperativeNausea and Vomiting (PONV) in laparoscopic surgery

Evaluation and Comparison of Two Different Combined Regimens for Prophylaxis of Nausea and Vomiting After Laparoscopic Bariatric Surgery: A Double-Blinded Randomized Clinical Trial

Postoperative Nausea and vomiting (PONV) are the most complications after laparoscopic surgeries, especially laparoscopic bariatric surgeries. The incidence of PONV has been estimated in over two-thirds of patients undergoing laparoscopic bariatric surgeries. Prophylactic combined antiemetic therapy is recommended for patients undergoing these surgeries. This is a double-blinded randomized clinical trial. Eighty-three patients of ASA physical status I and II undergoing elective bariatric laparoscopic surgery were enrolled in this clinical trial and divided into two equal groups through simple randomization using a random number table. One group (group A) received a combination of ondansetron, dexamethasone, and haloperidol (ODH); and the other group (group B) received a combination of ondansetron, dexamethasone, and promethazine (ODP). The ODP group received promethazine 25 mg IM 30 minutes before extubation and ODH group received haloperidol 2 mg IM at the beginning of the surgery. Nausea and vomiting were assessed in terms of severity and frequency in the recovery room, 6, and 24 hours postoperatively in both groups using the Numeric Verbal Rating Scale (NVRS). The frequency of PONV was significantly lower in the ODH group compared to the ODP group in the recovery room (20% versus 40%). PONV severity was lower in the ODH group compared to the ODP group. The time to first rescue antiemetic prescription in the ODP group was more than in the ODH group (7.2 h versus 2.6 h). In morbidly obese patients undergoing laparoscopic bariatric surgery, both antiemetic combinations decreased the incidence of PONV, but the combination of haloperidol, dexamethasone, and ondansetron was more effective than promethazine, dexamethasone, and ondansetron.

Sociodemographic Disparities in Postoperative Nausea and Vomiting.

Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. We conducted a retrospective analysis of all patients eligible for an institution-specific PONV prophylaxis protocol (2015-2017). Sociodemographic and PONV risk data were collected. Primary outcomes were PONV incidence and clinician adherence to PONV prophylaxis protocol. We used descriptive statistics to compare sociodemographics, procedural characteristics, and protocol adherence for patients with and without PONV. Multivariable logistic regression analysis followed by Tukey-Kramer correction for multiple comparisons was used to test for associations between patient sociodemographics, procedural characteristics, PONV risk, and (1) PONV incidence and (2) adherence to PONV prophylaxis protocol. Within the 8384 patient sample, Black patients had a 17% lower risk of PONV than White patients (adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.73-0.95; P = .006). When there was adherence to the PONV prophylaxis protocol, Black patients were less likely to experience PONV compared to White patients (aOR, 0.81; 95% CI, 0.70-0.93; P = .003). When there was adherence to the protocol, patients with Medicaid were less likely to experience PONV compared to privately insured patients (aOR, 0.72; 95% CI, 0.64-1.04; P = .017). When the protocol was followed for high-risk patients, Hispanic patients were more likely to experience PONV than White patients (aOR, 2.96; 95% CI, 1.18-7.42; adjusted P = .022). Compared to White patients, protocol adherence was lower for Black patients with moderate (aOR, 0.76; 95% CI, 0.64-0.91; P = .003) and high risk (aOR, 0.57; 95% CI, 0.42-0.78; P = .0004). Racial and sociodemographic disparities exist in the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. Awareness of such disparities in PONV prophylaxis could improve the quality of perioperative care.

Virtual Pain Unit Is Associated with Improvement of Postoperative Analgesia Quality: A Retrospective Single-Center Clinical Study.

Acute postoperative pain is a major concern among surgicalpatients. Thus, this study established a new acute pain management model and compared the effects of the acute pain service (APS) model in 2020 and the virtual pain unit (VPU) model in 2021 on postoperative analgesia quality. This retrospective, single-center clinical study involved 21,281 patients from 2020 to 2021. First, the patients were grouped on the basis of their pain management model (APS and VPU). The incidence of moderate to severe postoperative pain (MSPP) [numeric rating scale (NRS) score ≥ 5], postoperative nausea and vomiting (PONV), and postoperative dizziness were recorded. The VPU group recorded significantly lower MSPP incidence (1-12months), PONV, and postoperative dizziness (1-10months and 12months) compared with the APS group. In addition, the annual average incidence of MSPP, PONV, and postoperative dizziness in the VPU group was significantly lower than in the APS group. The VPU model reduces the incidence of moderate to severe postoperative pain, nausea, vomiting, and dizziness; hence, it is a promising acute pain management model.

Analgesic efficacy of systemic lidocaine using lean body mass based dosing regime versus placebo in bariatric surgery: a prospective, randomised, double-blind, placebo-controlled, single-centre study

BackgroundIntravenous lidocaine is used as an adjuvant analgesic agent in perioperative settings. It has been investigated in various patient populations and surgical interventions, but there are limited data on its efficacy, particularly for patients undergoing bariatric surgery. Obese patients are at high risk of postoperative respiratory complications and can be expected to benefit from anaesthetic techniques that minimise opioid administration. MethodsWe studied administration of lidocaine hydrochloride 1% i.v. to general anaesthesia at a dose of 1.5 mg kg−1 (lean body mass×1.28) or placebo in patients undergoing bariatric surgery. Subjects randomly assigned to each group were surveyed for 48 h after surgery for experienced pain (primary outcome), and administered opioids, postoperative nausea and vomiting (PONV), resumption of bowel function, and length of hospital stay (secondary outcomes). ResultsWe recruited and randomised 140 subjects to either the lidocaine or placebo group; 137 completed the study. Subjects with pain numeric rating scale (NRS) >3 within the first 4 h postoperatively were similar in both groups (proportion of any NRS >3 within first 4 h lidocaine group: 47/68 (69%) vs placebo group: 44/69 (63%), P=0.507; within first h P=0.177, within second h P=0.513, within third h P=0.145, within fourth h P=0.510). There was no difference in maximal pain score, opioid consumption, recovery of bowel function, incidence of PONV, or length of hospital stay. ConclusionsLidocaine does not improve postoperative pain scores, analgesia, or any secondary outcomes in patients undergoing bariatric surgery. Clinical trial registrationNCT03667001.

The effect of lidocaine intraoperative infusion on quality of postoperative sleep in patients undergoing thyroidectomy: a randomized controlled trial

BackgroundThe incidence of thyroid nodules has increased significantly in recent years, and surgical removal is a common treatment. Postoperative sleep disturbance is still a serious problem in the current surgical environment. In this study, we explored whether intraoperative lidocaine infusion could improve the quality of sleep over 7 days and 30 days after surgery and postoperative recovery for patients undergoing thyroid surgery.MethodsSeventy patients who underwent thyroid surgery from October 2020 to June 2021 were randomly assigned to the lidocaine or the normal saline group, 35 cases in each group. Patients enrolled in this study were randomized to receive either system lidocaine (a bolus of 1.5 mg·kg− 1, followed by an infusion of 2 mg·kg− 1·h− 1 until the end of the surgical procedure) or identical volumes and rates of normal saline. The primary endpoint was the Pittsburgh Sleep Quality Index (PSQI) scores. Secondary endpoints included intraoperative remifentanil consumption, whether there was a cough within 5 min after extubation and the cough scores, postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV).ResultsTotally seventy cases were enrolled and eventually sixty-eight cases were analyzed. PSQI scores did not change significantly over time (F = 2.799, P = 0.069); also, there was no significant difference in PSQI scores between two groups in the entire 30 days follow-up period (F = 0.174, P = 0.678). Further, there was no interaction between the time points and the intervention (F = 0.649, P = 0.513). Similarly, intraoperative remifentanil consumption, the incidence of cough and postoperative pain scores, were comparable between the two groups (all P > 0.05); while patients in the lidocaine group showed significantly lower cough scores (P = 0.042) and lower incidence of PONV (P = 0.015).ConclusionsSystemic lidocaine infusion might not improve the sleep quality and reduce postoperative pain over 7 days or 30 days after the operation of patients who underwent thyroid surgery, but it can reduce postoperative complications and improve the quality of recovery. Furthermore, sleep quality of patients wasn’t impaired significantly in the entire 30 days follow-up period after thyroid surgery compared with baseline values.Trial registrationRegistered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn, identifier: ChiCTR2000039764, date: 08/11/2020)

Clinical and genetic factors associated with post-operative nausea and vomiting after propofol anaesthesia.

The incidence of post-operative nausea and vomiting (PONV) remains at about 30% despite all therapeutic efforts to reduce it. The clinical risk factors guiding the prophylactic treatment are well established, but genetic factors associated with PONV remain poorly known. The aim of this study was to explore clinical and genetic factors impacting PONV by performing a genome-wide association study (GWAS) together with relevant clinical factors as covariates, and systematically attempt to replicate previously reported PONV associations. Relevant clinical factors are explored with logistic regression model. This was an observational case control study in Helsinki University Hospital between 1 August 2006 and 31 December 2010. One thousand consenting women with elevated risk for PONV, undergoing breast cancer surgery with standardised propofol anaesthesia and antiemetics. After exclusions for clinical reasons and failed genotyping, 815 patients were included with 187 PONV cases and 628 controls. Emergence of PONV up to 7th post-operative day was recorded. PONV at 2-24 h after surgery was selected to be the primary outcome. The GWAS explored associations between PONV and 653 034 genetic variants. Replication attempts included 31 variants in 16 genes. The overall incidence of PONV up to 7th post-operative day was 35%, where 3% had PONV at 0-2 h and 23% at 2-24 h after surgery. Age, American Society of Anaesthesiologists status, the amount of oxycodone used in the post-anaesthesia care unit, smoking status, previous PONV, and history of motion sickness were statistically significant predictive factors in the logistic model. The receiver operating characteristic-area under the curve of 0.75 (95% CI 0.71-0.79) was calculated for the model. The GWAS identified six variants with suggestive association to PONV (p < 1 × 10-5 ). Of the previously reported variants, association with the DRD2 variant rs18004972 (TaqIA) was replicated (p = .028). Our GWAS approach did not identify any high-impact PONV susceptibility variants. The results provide some support for a role of dopamine D2 receptors in PONV.

Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis.

Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10mmHg) with standard IAP (10mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10mmHg) leads to a lower incidence of mild (Clavien-Dindo grade 1-2) postoperative complications (RR=0.68, 95% CI: 0.53-0.86), lower pain scores (MD=-0.68, 95% CI: -0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51-0.88), and a reduced length of hospital stay (MD=-0.29, 95% CI: -0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77-1.73). Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.

ST36 acupoint injection with anisodamine for postoperative nausea and vomiting in female patients after bariatric surgery: a prospective, randomized controlled trial

BackgroundThe use of multimodal pharmacological prophylactic regimes has decreased postoperative nausea and vomiting (PONV) in general but it still occurs in over 60% of female patients after bariatric surgery. This study aimed to evaluate the efficacy of ST36 acupoint injection with anisodamine in prevention of PONV among female patients after bariatric surgery.MethodsNinety patients undergoing laparoscopic sleeve gastrectomy were randomly allocated to anisodamine or control group at the ratio of 2:1. Anisodamine or normal saline was injected into Zusanli (ST36) bilaterally after induction of general anesthesia. The incidence and severity of PONV were assessed during the first 3 postoperative days and at 3 months. The quality of early recovery of anesthesia, gastrointestinal function, sleep quality, anxiety, depression, and complications were also evaluated.ResultsBaseline and perioperative characteristics were comparable between two groups. In the anisodamine group, 25 patients (42.4%) experienced vomiting within postoperative 24 h compared with 21 (72.4%) in the control group (relative risk 0.59; 95% confidence interval 0.40–0.85). Time to first rescue antiemetic was 6.5 h in anisodamine group, and 1.7 h in the control group (P = 0.011). Less rescue antiemetic was required during the first 24 h in the anisodamine group (P = 0.024). There were no differences in either postoperative nausea or other recovery characteristics.ConclusionsThe addition of ST36 acupoint injection with anisodamine significantly reduced postoperative vomiting without affecting nausea in female patients with obesity undergoing laparoscopic sleeve gastrectomy.

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

BackgroundRemimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery.MethodsPatients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery.ResultsThe incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05).ConclusionsIn this study, remimazolam did not increase the incidence and severity of PONV compared with propofol.Trial registrationKCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.

Analysis of the impact of the type of anaesthesia and its side effects on postoperative rehabilitation during spine surgery

Background. Spine surgeries belong to traumatic, complex, long-term interventions and can be carried out using various methods of anaesthesia. Each type of anaesthesia has its own side effects and complications, such as postoperative nausea and vomiting (PONV). Often it is related to the amount of narcotic analgesic used. PONV directly affects the patient’s overall satisfaction with anaesthesia. Spine operations require intensive pain management with narcotic analgesics. Regional anaesthesia allows reducing the amount of narcotic analgesics and control the pain syndrome. The purpose was to compare erector spinae plane (ESP) block as a component of combination with general anaesthesia in the context of the impact on the number of narcotic analgesics, PONV and general satisfaction with anaesthesia. Materials and methods. Spine surgery was performed in 83 patients. Depending on the method of analgesia, they were divided into 2 groups: group I — general anaesthesia, group II — general anaesthesia with ESP block. Primary outcomes: amount of intraoperative fentanyl and postoperative morphine. Secondary final clinical outcomes of the study: incidence of PONV, overall satisfaction with anaesthesia on a 5-point Likert scale. Results. The total amount of fentanyl was lower in group II (1.7 ± 0.7 μg/kg/h) compared to group I (4.7 ± 1.6 μg/kg/h), p &lt; 0.05. Morphine was administered to 31 patients in group I and 6 patients in group II. The frequency of PONV episodes was lower in group II (29 cases) than in group I (11 cases). Overall satisfaction with anaesthesia was higher in group II (4.38 ± 0.80) in contrast to group I (2.97 ± 0.90), p &lt; 0.05. Conclusions. ESP block as a component of general anaesthesia reduces the amount of narcotic analgesics intra- and postoperatively and, as a result, decreases the frequency of PONV and improves overall satisfaction with anaesthesia.

Development and assessment of novel machine learning models to predict the probability of postoperative nausea and vomiting for patient-controlled analgesia

Postoperative nausea and vomiting (PONV) can lead to various postoperative complications. The risk assessment model of PONV is helpful in guiding treatment and reducing the incidence of PONV, whereas the published models of PONV do not have a high accuracy rate. This study aimed to collect data from patients in Sichuan Provincial People’s Hospital to develop models for predicting PONV based on machine learning algorithms, and to evaluate the predictive performance of the models using the area under the receiver characteristic curve (AUC), accuracy, precision, recall rate, F1 value and area under the precision-recall curve (AUPRC). The AUC (0.947) of our best machine learning model was significantly higher than that of the past models. The best of these models was used for external validation on patients from Chengdu First People’s Hospital, and the AUC was 0.821. The contributions of variables were also interpreted using SHapley Additive ExPlanation (SHAP). A history of motion sickness and/or PONV, sex, weight, history of surgery, infusion volume, intraoperative urine volume, age, BMI, height, and PCA_3.0 were the top ten most important variables for the model. The machine learning models of PONV provided a good preoperative prediction of PONV for intravenous patient-controlled analgesia.

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study.

Objective: The optimal dose of epidural morphine after cesarean section (CS) still remains unknown when combined with low-concentration ropivacaine based on a continuous basal infusion (CBI) mode. The aim of this study was to assess the impact of different dose of epidural morphine plus ropivacaine on maternal outcomes. Materials and methods: Data of parturients who received epidural analgesia for CS at a teaching hospital from March 2021 to June 2022 were retrospectively collected. Parturients were divided into two groups (RM3 group and RM6 group) according to different medication regimens of morphine. The implementation of epidural analgesia was performed with 3mg morphine in RM3 group and 6mg morphine in RM6 group in combination with 0.1% ropivacaine via a CBI pump. The primary outcomes included pain intensity at rest and movement and the incidence of urinary retention and pruritus within postoperative 48h. The secondary outcomes included the incidence and severity of postoperative nausea and vomiting (PONV) and pruritus, the rate of rescue analgesia and grading of motor Block. Results: Totally, 531 parturients were eligible for the final analysis, with 428 and 103 parturients in the RM3 group and RM6 group, respectively. There were no statistically significant differences in the visual analogue scores (VAS) at rest and movement within postoperative 48h between the two groups (all p > 0.05). Compared with the RM6 group, the incidence of urinary retention was lower in the RM3 group within 48h after CS (4.0% vs. 8.7%, p = 0.044). No significant difference was found in the incidence and severity of PONV and pruritus, the rate of rescue analgesia and grading of motor block between RM3 and RM6 groups. Conclusion: Epidural 3mg morphine plus 0.1% ropivacaine in a CBI mode can provide equal efficacy and have lower incidence of urinary retention compared with 6mg morphine after CS.

Effects of sugammadex versus neostigmine on postoperative nausea and vomiting after general anesthesia in adult patients:a single-center retrospective study

We aimed to compare the effect of sugammadex to that of neostigmine with respect to the occurrence of postoperative nausea and vomiting (PONV) during the first 24 h following general anesthesia. This retrospective cohort study included patients who underwent elective surgery under general anesthesia in 2020 at an academic medical center in Seoul, South Korea. The exposure groups were determined according to whether the patient received sugammadex or neostigmine as a reversal agent. The primary outcome was PONV occurrence during the first 24 h postoperatively (overall). The association between the type of reversal agent and primary outcome was investigated using logistic regression while adjusting for confounding variables using stabilized inverse probability of treatment weighting (sIPTW). Of the 10,912 patients included in this study, 5,918 (54.2%) received sugammadex. Sugammadex was associated with a significantly lower incidence of overall PONV (15.8% vs. 17.7%; odds ratio, 0.87; 95% confidence interval [CI], 0.79–0.97; P = 0.010) after sIPTW. In conclusion, compared with neostigmine/glycopyrrolate, sugammadex use has a lower risk of PONV during the first 24 h following general anesthesia.