Occurrence Of Postoperative Nausea Research Articles

The comparison of erector spinae plane block and caudal block for postoperative analgesia in paediatric surgery - meta-analysis

<p><strong>Aim </strong>To assess the efficacy of Erector Spinae Plane Block (ESPB) compared to caudal block in reducing postoperative pain in paediatric surgery.<br /><strong>Methods </strong>An electronic literature search was conducted using the Cochrane Library, PubMed, and Google Scholar databases, with data collected from January 2018 until September 2023. This meta-analysis includes English-language randomized controlled trials (RCTs) studies contrasting ESPB with caudal block in paediatric patients. The primary outcome was the 24-hour postoperative pain scores. The secondary outcome included the time to rescue analgesia, the number of patients requiring rescue analgesia, and the occurrence of postoperative nausea and vomiting (PONV) and urinary retention.<br /><strong>Results </strong>Five RCTs with 295 samples were included. The results showed no significant difference between ESPB and caudal block in postoperative pain scores at 1st hour SMD (standardized mean difference)  of  -0.17 (95% CI -0.70, 0.36; I2=76%; p= 0.53), 2nd hour of SMD: -0.50 (95% CI -1.21, 0.21; I2=88%; p=0.17), 6th hour SMD -1.09 (95% CI -2.21, 0.03; I2=95%; p = 0.06), 12th hour SMD -0.77 (95% CI -1.75, 0.21; I2=93%; p=0.12), and the 24th hour SMD -0.13 (95% CI -0.39, 0.12;, I2=2%; p=0.30) were found. Furthermore, there was no significant difference in the time first to rescue analgesia, the number of patients requiring analgesia rescue, PONV occurrence, and urinary retention.<br /><strong>Conclusion </strong>ESPB and caudal block showed equivalent analgesia efficacy and safety in paediatric surgery.</p>

A randomised, double blinded control study to compare the efficacy of intraperitoneal nebulization and instillation of ropivacaine for postoperative pain relief in patients undergoing laparoscopic appendicectomy

: Patients scheduled for laparoscopic appendicectomy encounter moderate to severe shoulder pain on the first postoperative day. Intraperitoneal nebulization of local anaesthetics is a new technique which provides uniform spread of local anaesthetic drug particles all through the peritoneum thus providing enhanced analgesic efficacy when compared to intraperitoneal instillation which provides non uniform distribution of the drug. : Fifty participants posted for laparoscopic appendicectomy under general anesthesia were randomized into Group A (Intraperitoneal nebulization of 8ml ropivacaine 0.75%) and Group B (intraperitoneal instillation of 8ml ropivacaine 0.75%). Our primary aim was to evaluate analgesic efficacy in both the groups postoperatively. Our secondary objectives were to compare the incidence of shoulder pain post operatively, total 48 hours fentanyl consumption and postoperative complications like nausea & vomiting and paralytic ileus. : There was statistically significance in the pain scores at 24 hours (static pain p=0.003 and dynamic pain p=0.005) & at 48 hours after surgery (static pain p=0.00 and dynamic pain p=0.015). Significant difference was seen in the incidence of shoulder pain. In Group A, no patients complained pain in shoulders while in Group B a maximum of 6 patients complained shoulder pain postoperatively (p=0.022). The total fentanyl consumption over 48 hours was 0.20 ± 0.005 in Group A and 0.80 ± 0.957 in Group B (p = 0.008). Occurrence of postoperative Nausea & Vomiting were similar in both groups. None of the patients complained paralytic ileus in both groups as systemic absorption of the ropivacaine is also considerably less in comparison to other local anaesthetic drugs . : Intraperitoneal nebulized ropivacaine provides greater reduction in postop pain, lesser consumption of opioids, reduction in referred shoulder pain in laparoscopic appendicectomy patients.

Personal versus therapist perioperative music intervention: a randomized controlled trial.

Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music. A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18-60years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery. Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T 0 : 124.3±13.7, 95% CI:121-127.7; T 20min : 117.6±10.4, 95% CI:115-120.1; T 30min : 116.9±10.6, 95% CI:114.3-119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1-Q3, Control: 3, 1-3; TT: 3, 1-4; PI: 3, 1-3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0-37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4-35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1-Q3, C: 8, 6-8; TT: 8, 7-9; PI: 8, 7-9). Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.

The Relationship Between Pre-Anesthesia Anxiety and the Incidence of Post-Operative Nausea and Vomiting (PONV) in Patients Undergoing General Anesthesia at Islamic Hospital Purwokerto

Background: The anaesthetic method employed during surgical procedures may cause pre-anaesthesia apprehension to increase, which is strongly associated with the occurrence of post-operative nausea and vomiting (PONV), which signifies alterations in psychological and physiological responses. Purpose: To examine the correlation between pre-anaesthesia anxiety and the occurrence of post-operative nausea and vomiting among Islamic Hospital Purwokerto patients undergoing general anaesthesia. Implementing Methods: By utilising a total sampling technique and an analytical approach with a cross-sectional design, 59 patients undergoing surgery under general anaesthesia in April 2023 were included. We gathered primary data by administering pre-anesthesia and post-anesthesia PONV questionnaires to patients in the inpatient ward. Findings: Most patients analysed by patient characteristic analysis were between the ages of 36 and 45 (33.90%), female (62.71%), had completed secondary school (54.24%), and were classified as ASA 2 (84.05%). The majority (72.88%) underwent moderate surgery, and all patients received 100% family support. Panic (49.2%), severe anxiety (42.4%), and moderate anxiety (8.5%) were the most prevalent responses. Moderate (6.7%), severe-to-moderate (28.8%), and severe (64.4%) nausea and vomiting were reported by the majority. A significant relationship exists between pre-anaesthesia anxiety and the incidence of post-operative nausea and vomiting (PONV) in patients undergoing general anaesthesia at Islamic Hospital Purwokerto, as indicated by the chi-square statistic = 0.016). Conclusion: The chi-square statistic indicates a significant relationship between pre-anaesthesia anxiety and the incidence of PONV in patients undergoing general anaesthesia at Islamic Hospital Purwokerto.

Dexamethasone Decreased Postoperative Complications in Tonsillotomy

PurposeTonsillotomy (TT) is a new and popular method with partial resection of the tonsils. Dexamethasone is often used during surgery for its anti-inflammatory, antiemetic, and analgesic properties. In this study, we aimed to explore the effect of systemic steroids use on postoperative vomiting, pain, and bleeding in TT. DesignA randomized controlled trial. MethodsWe enrolled 240 children aged 2 to 18 years who had undergone TT or adenotonsillotomy at our center from July 2020 to July 2021. Dexamethasone or 0.9% normal saline was administered before the start of surgery. Postoperative hemorrhage, vomiting, and nausea were recorded and compared between groups. FindingsThe dexamethasone group had a 2.5% (3/119) rate of postoperative bleeding, while the rate was 1.6% (2/119) in the control group. No patients required multiple operations for control of bleeding. The degree of postoperative pain (2.1 ± 0.5 vs 3.4 ± 0.9) and the occurrence of postoperative nausea (21% vs 31.9%), as well as vomiting (15% vs 24.4%) in the dexamethasone group, was significantly lower compared with the placebo group. ConclusionsThe rate of postoperative bleeding between the dexamethasone group and the control group had no significant difference, suggesting the high safety of dexamethasone use in TT. Dexamethasone use in TT improved postoperative pain, nausea, and vomiting significantly.

Use of virtual reality in port implantation to reduce perioperative anxiety and pain: protocol for a randomised controlled pilot trial at a single German university hospital (VIP-trial; DRKS00028508)

IntroductionIntravenous access port implantation is commonly performed under local anaesthesia, which offers advantages such as increased patient satisfaction and resource savings compared with general anaesthesia. However, patients may experience increased...

Pericapsular Nerve Group Block Leads to Small but Consistent Reductions in Pain Between 18 and 24 Hours’ Postoperatively in Hip Arthroscopy for Femoroacetabular Impingement Surgery: A Prospective, Randomized Controlled Clinical Trial

To investigate whether the use of a pericapsular nerve group (PENG) block would reduce perioperative pain after arthroscopic therapy for femoroacetabular impingement syndrome (FAIS) and to examine opioid requirements and occurrence of postoperative nausea and vomiting (PONV). Between May 2022 and October 2022, patients (N= 68) undergoing arthroscopic surgery for FAIS were randomly allocated into 2 groups. The first group received an ultrasound-guided PENG preoperatively with 20 mL of 0.375% ropivacaine and standardized postoperative oral medication. The second group received a sham block preoperatively with 20 mL of 0.9% saline and standardized postoperative oral medication. The primary end point was pain scores (visual analog score [VAS], 0-10) during the first 24 hours postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the minimal clinically important difference (MCID) was calculated using the half standard deviation method. The incidence of PONV as well as opioid usage (converted to morphine equivalent) within the first 24 hours were secondary outcomes. Randomization and permission were successfully obtained from 68 participants. From the fifteenth postoperative hour, the PENG group reported significantly less postoperative pain than the control group (24th postoperative hour: VAS pain PENG group 1.3 ± 0.9 [0-3]; 95% confidence interval {CI} 0.4-1.2 vs the VAS pain control group 2.4 ± 1.6 [0-5]; 95% CI 1.4-4.7; P= .009). The VAS pain score threshold for achieving the MCID at 24 hours postoperative was defined as a decrease of 1.1. 27 patients (79%) in the PENG group and 22 patients (65%) in the control group were able to achieve MCID (P= .009). Opioid dosage and postoperative nausea did not differ significantly between groups (P=.987 and P= .655, respectively). Concomitant complications such as falls, hematomas, or weakened muscles did not occur in either group. According to this study, a PENG block minimally reduced pain after arthroscopic treatment for FAIS between the 18th and 24th postoperative hours. The PENG group achieved significantly more often the pain VAS MCID. However, there was no proof that the PENG group consumed fewer opioids than the control group. Overall, PONV was found at a low and comparable rate. Level I, randomized controlled trial.

The Effect of Single Dose Dexamethasone on Postoperative Pain and Post Operative Nausea Vomiting in Patients Undergoing Breast Surgery Under General Anaesthesia

Objective: The primary purpose of this study is to assess the efficacy of intravenous dexamethasone in preventing postoperative nausea and vomiting in patients who have had breast surgery under general anesthesia. Methods: After ethical approval from institution review board, this randomized control was carried out at Liaqat national hospital and medical college. Seventy-four patients who completed the study's criteria and provided written informed permission were enrolled in a random order. Patients were recruited and then randomly assigned through balloting without replacement to one of two groups: (A) dexamethasone (n = 37) or (B) placebo (n = 37). After general anesthesia, patients in Group received 0.1mg/kg of dexamethasone intravenously at the same time. Patients in Group B received a placebo (2 ml of normal saline 0.9% at the same time following general anesthesia). Mean arterial blood pressure (MAP), heart rate (HR), respiration rate (RR), and the intensity of pain and vomiting was measured at 0 (in the operating room), 30, 60, and 120 minutes, and 4-, 6-, 12-, and 24-hours following surgery. Results: The mean age of the participants in both study groups were 48.56±15.25 and 50.4±16.8 years. The mean anesthesia time of the participants in both study groups were 114±9.6 and 122.7±8.7 minutes. The mean surgery time of the participants in both study groups were 88.2±2.1 and 96.1±3.72 minutes. No significant difference in the heart rate (HR) was observed in both study groups at any time interval. A significant difference in the heart rate was observed in both study groups at 6-, 12-, and 24-hours’ time interval. A significant difference in the heart rate was observed in both study groups at 0 and 30 minutes, 1-,2-,4-, 6-, 12-, and 24-hours’ time interval. Conclusion: There were no notable changes in vital signs associated with the use of intravenous dexamethasone for the treatment of postoperative pain, the need for rescue analgesia on postoperative day 1, or the occurrence of postoperative nausea and vomiting. Keywords: Visual analog score, nausea, vomiting, pain, dexamethasone

Effect of Implementing Acupressure Technique on Gastrointestinal Problems and Pain Control for Children Post Abdominal Surgeries

Abdominal surgeries are defined as procedures carried out by surgeons for the children's abdominal regions for treating a medical condition. Pediatric surgical problems are a broad spectrum of surgical condition that occurs in children. Sometimes, it is considered a proper option of pediatric management to save children's lives and prevent and decrease disabilities and death. Aim: evaluate the effect of the acupressure technique on gastrointestinal problems and pain control for children post-abdominal surgeries. Methods: the study was a quasi-experimental research design and used for 80 children from the Tanta Main University Hospital's pediatric surgical department. Tools: were used to collect data: A structured Interview Schedule to assess the socio-demographic characteristic and medical history of children, a Rhodes index of nausea and vomiting form to assess nausea and vomiting, and a visual analog scale to assess nausea, vomiting and pain. Results: The current study found statistically significant differences in the occurrence of postoperative nausea, vomiting, and pain on the first- and second-days following implementation. Conclusion: There are a significant improvement in the children's nausea, vomiting, and pain after abdominal surgeries. Recommendations: Acupressure should be utilized as a collaborative nursing intervention method to minimize post-operative gastrointestinal side effects (nausea and vomiting) in pediatric surgery patients.

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

Study designRetrospective case series.ObjectivesThis study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction.MethodsThe data of 282 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH.ResultsOf 282 patients, 197 (69.86%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH.ConclusionOur study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial

BackgroundParathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy.MethodsEighty-two uremia patients who underwent parathyroidectomy and exhibited SHPT were randomly allocated to the BSCPB group or the control group (CON group). The patients received ultrasound-guided BSCPB with 7.5 ml of ropivacaine 0.5% on each side (BSCPB group) or equal amount of 0.9% normal saline (CON group). The primary outcome of the Quality of Recovery-40(QoR-40) score was recorded on the day before surgery and postoperative day 1(POD1). Secondary outcomes including total consumption of remifentanil, time to first required rescue analgesia, number of patients requiring rescue analgesia, and total consumption of tramadol during the first 24 h after surgery were recorded. The occurrence of postoperative nausea or vomiting (PONV) and the visual analogue scale (VAS) scores were assessed and recorded.ResultsThe scores on the pain and emotional state dimensions of the QoR-40 and the total QoR-40 score were higher in the BSCPB group than in the CON group on POD1 (P = 0.000). Compared with the CON group, the total consumption of remifentanil was significantly decreased in the BSCPB group (P = 0.000). The BSCPB group exhibited longer time to first required rescue analgesia (P = 0.018), fewer patients requiring rescue analgesia (P = 0.000), and lower postoperative total consumption of tramadol during the first 24 h after surgery (P = 0.000) than the CON group. The incidence of PONV was significantly lower in the BSCPB group than in the CON group (P = 0.013). The VAS scores in the BSCPB group were lower than those in the CON group at all time-points after surgery (P = 0.000).ConclusionUltrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV in uremia patients with SHPT following parathyroidectomy.Trial registrationChiCTR1900027185. (Prospective registered). Initial registration date was 04/11/2019.

Serratus anterior plane block reduces the prevalence of chronic postsurgical pain after modified radical mastectomy: A randomized controlled trial

Study objectiveTo determine whether ultrasound-guided serratus anterior plane block (SAPB) is associated with decreased prevalence of chronic postsurgical pain (CPSP) after modified radical mastectomy. DesignRandomized, double-blind, placebo-controlled study. SettingUniversity hospital. PatientsWe enrolled 198 patients aged 18–65 years with American Society of Anesthesiologists physical status I to II, undergoing unilateral modified radical mastectomy. InterventionsPatients were randomly allocated to receive SAPB with 30 ml of 0.5% ropivacaine (SAPB group) or 0.9% normal saline (Control group). MeasurementsThe primary outcome was the prevalence of CPSP three months after surgery. Secondary outcomes were area under the curve of the numeric rating scale pain scores over 24 h, postoperative 24-h morphine consumption, quality of recovery, length of post-anesthesia care unit stay, postoperative nausea and vomiting, dizziness, SAPB-related adverse events, the prevalence of CPSP at six months, and pain-related function at three and six months. Main resultsPreoperative SAPB with 0.5% ropivacaine reduced the prevalence of CPSP at three postoperative months from 46/89 (51.7%) to 22/90 (25.6%), relative risk (95% confidence interval): 0.47 (0.31–0.72), P < 0.001. The prevalence of CPSP was reduced at six months from 37/89 (41.6%) to 17/90 (18.9%), relative risk (95% confidence interval): 0.72 (0.58–0.88), P = 0.001. Moreover, SAPB decreased the area under the curve of the numeric rating scale pain scores over 24 h, shortened the length of post-anesthesia care unit stay, reduced postoperative 24-h morphine consumption and the occurrence of postoperative nausea and vomiting, and improved quality of recovery and patient satisfaction, with P < 0.05 for all. No SAPB-related complications occurred. ConclusionsPreoperative SAPB with ropivacaine improved acute postoperative analgesia and quality of recovery and decreased the prevalence of CPSP at three and six months after modified radical mastectomy.

Mechanism and risk factors of nausea and vomiting after TACE: a retrospective analysis

PurposeThe mechanism of postoperative nausea and vomiting after TACE is not clear. This study retrospectively analyzed the patient data to explore the mechanism and risk factors of postoperative nausea and vomiting after TACE.Materials and methodsThe data of 221 patients who underwent TACE in the interventional department from January 2019 to December 2020 were collected. Including: gender, age, liver function before TACE, etiology of liver cirrhosis, BCLC stage of hepatocellular carcinoma, preoperative use of analgesic drugs, preoperative limosis, previous history of vomiting, history of kinetosis, smoking history, history of drinking, chemotherapeutic drugs used during TACE, Dosage of lipiodol, and occurrence of postoperative nausea and vomiting.ResultsThere were 116 cases of nausea after TACE, using binary logistic regression analysis, Sig: ALT0.003; ALP0.000; history of vomiting 0.043; kinetosis 0.006; history of alcohol consumption 0.011; preoperative limosis 0.006; dosage of lipiodol (5–10 mL) 0.029, dosage of lipiodol (> 10 mL) 0.001.There were 89 cases of vomiting after TACE, all accompanied by nausea, Sig: ALP0.000; BCLC stage (B) 0.007; kinetosis 0.034; chemotherapeutic drugs 0.015; dosage of lipiodol (5–10 ml) 0.015, dosage of lipiodol (> 10 ml) 0.000; patients used analgesics before TACE 0.034.ConclusionsCauses of post-TACE nausea and vomiting included operative trauma, aseptic inflammation caused by ischemia and hypoxia, chemotherapeutic drugs, ischemia of liver and bile duct, stress and pain during TACE, and patient factors. ALP, BCLC stage, kinetosis, chemotherapeutic drugs, dosage of lipiodol, and preoperative usage of analgesics were risk factors affecting nausea and vomiting after TACE.

ВНУТРИВЕННАЯ ИНФУЗИЯ ЛИДОКАИНА В ХИРУРГИИ ТРАХЕИ

Objective. To evaluate the possibility of using intravenous infusion of lidocaine in tracheal surgery. Methods. The analysis of case histories of patients (n=19) operated on for tracheal stenosis was carried out. Depending on the perioperative analgesia, the patients were divided into two groups: the 1&lt;sup&gt;st&lt;/sup&gt; group (n=9) - intravenous infusion of lidocaine; the 2&lt;sup&gt;nd&lt;/sup&gt; - (n = 10) - narcotic analgesics. Tracheal resection was carried out using the cervical access. Before tracheal transection and after tracheal anastomosis was applied, protective mechanical ventilation of the lungs was performed. The stage of tracheal resection and formation of anastomosis is high-frequency jet ventilation (HFJV). Anesthesia was maintained with sevoflurane, and after opening the tracheal lumen - with propofol 6-8 mg/kg/h. In the first group, an intravenous bolus of lidocaine 1.5 mg / kg was added to the induction, followed by a continuous infusion of 1.5 mg / kg / h during surgery. The concentration of lidocaine was determined 15 minutes after the bolus and 24 h after surgery. Hemodynamics, acid-base state, glycemia, response to the endotracheal tube, time of extubation, occurrence of postoperative nausea and vomiting were assessed. Pain syndrome was assessed using a visual analogue scale every 15 minutes for an hour, and then every 4 hours until the end of the first day, the consumption of opioids was recorded. Results. Group 1 patients were extubated without agitation; the pressor response to extubation was less pronounced. Mean arterial pressure, blood gas composition and glycemia did not differ between these groups. There were no signs of systemic toxicity of lidocaine. Group 1 patients did not need promedol and tramadol, and the median and percentiles in group 2 patients, both for promedol and tramadol, were 60 [30; 60] and 400 [200; 400] mg, respectively. Four patients in group 2 had postoperative nausea and vomiting. Conclusion. Intravenous infusion of lidocaineis considered to be an alternative to perioperative opioid analgesia in tracheal surgery performed from the cervical approach. What this paper adds For the first time, in the case of the impossibility and absence of the need for a thoracic epidural block the intravenous application of lidocaine for analgesic purposes in tracheal surgery was studied. It was found that the use of intravenous infusion of lidocaine reduces the incidence of postoperative nausea and vomiting (PONV) caused by the use of opioids, and also showed a trend toward adecreased pressor responseto the endotracheal tube upon awakening of patients.

Granisetron vs. Granisetron and Dexamethasone on The Reduction of Postoperative Nausea and Vomiting (PONV) After Caesarean Section With Intrathecal Morphine: A Randomised Controlled Trial

ABSTRACT Background Intrathecal morphine (ITM) has proven to be excellent in reducing postoperative pain. However, its use is associated with the occurrence of postoperative nausea and vomiting (PONV). In this study, we wish to compare the efficacy between the combination therapy of granisetron and dexamethasone versus granisetron alone on the occurrence of postoperative nausea and vomiting (PONV) in parturients undergoing elective Caesarean delivery. Method This is a prospective double-blinded, randomised controlled trial (RCT) involving 126 parturients of American Society of Anesthesiologist (ASA) physical status I and II undergoing elective Caesarean deliveries. Subjects were randomly allocated into 2 groups (n = 63), to either receive a combination of 1 mg intravenous (IV) granisetron plus 4 mg IV dexamethasone (Group A) or to receive 1 mg IV granisetron (Group B). They were assessed at 1, 4, 8, 12 and 24-hour postoperatively. Episodes of nausea, retching, vomiting and the requirement of rescue antiemetics at these time intervals were recorded. Results There are no statistically significant differences in the occurrence of nausea, retching and vomiting between both groups at 1, 4, 8, 12 and 24 h postoperatively. The usage of rescue antiemetics were similar in both groups of subjects. Conclusion The use of granisetron is comparable with the use of granisetron and dexamethasone in the prevention of PONV in parturients receiving intrathecal morphine for elective Caesarean section.

Sugammadex versus neostigmine for routine reversal of rocuronium block in adult patients: A cost analysis

Study objectiveThis report analyzes the comparative costs, efficacy and side effects of a newer, more expensive reversal drug, sugammadex, with its generic counterpart, neostigmine combined with glycopyrrolate, or no reversal agent when used routinely to reverse rocuronium-induced neuromuscular blockade in adult patients. DesignCost analysis. MethodsWe constructed a decision model to analyze the costs associated with the choice of reversal drug and differences in reversal time, occurrence of postoperative nausea or vomiting (PONV), and residual blockade requiring unplanned postoperative mechanical ventilation (UPMV). We selected variables that demonstrated meaningful differences in meta-analyses of published studies and/or had significant associated costs. We used data from local hospital system information, meta-analysis of published studies, and the general literature to construct base-case scenarios and sensitivity analyses. We performed the analysis from the perspective of a single hospital system. Costs were in 2019 U.S. dollars. ResultsCost analysis suggested that reversal with sugammadex is preferable to neostigmine or no reversal drug when operating room (OR) time was valued at ≥$8.60/min (base case $32.49/min). Net costs of sugammadex were less than no treatment or neostigmine reversal when the probability of UPMV exceeded 0.019 and 0.036, respectively. Neither sugammadex nor neostigmine reversal was preferable to no treatment in a base-case analysis that considered the effect of the reversal agent on only drug and PONV costs, disregarding costs of OR time or UPMV. ConclusionsRoutine reversal with sugammadex is preferable to choosing neostigmine or no reversal drug when accounting for potential savings in OR time. Sugammadex might also be a reasonable choice for patients at high risk of UPMV. If the cost of OR time is not considered, the analysis does not support the routine use of sugammadex in patients with perceived increased risk or solely to reduce PONV.

Erector spinae plane block versus retrolaminar block for postoperative analgesia after breast surgery: a randomized controlled trial.

The newly introduced erector spinae plane block (ESPB) has given anesthesiologists an alternative regional anesthetic technique for thoracic analgesia. Although ESPB and retrolaminar block (RLB) have similar puncture sites, no clinical study comparing ESPB and RLB has been reported. The aim of this study was to compare ESPB and RLB in terms of analgesic efficacy in the context of multimodal analgesia following breast surgery. Fifty female patients undergoing breast surgery under general anesthesia were randomly allocated to receive either ultrasound-guided ESPB or RLB with 20mL of 0.375% levobupivacaine for postoperative analgesia. The primary outcome was analgesic efficacy in terms of time to first postoperative rescue analgesic after the block procedure. The secondary outcomes were consumption of remifentanil during anesthesia, pain intensity at rest for 24h postoperatively, and occurrence of postoperative nausea and vomiting (PONV). After excluding five patients, 45 patients (22 and 23 patients in the ESPB and RLB group, respectively) were analyzed. Median time until the first postoperative rescue analgesic after the block procedure in the ESPB group was not significantly longer than that in the RLB group (8.6 [range 2.7-24] vs. 4.8 [3.0-24] h; P = 0.83). There was no significant difference in the consumption of remifentanil during anesthesia, pain intensity at rest for 24h postoperatively, and occurrence of PONV between the two groups. ESPB is equivalent, and not superior, to RLB for postoperative analgesia after breast surgery when 20mL of 0.375% levobupivacaine is injected at the fourth thoracic vertebra.

Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?

Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment? There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although muscular tissue oxygen saturation-guided care did not reduce the overall occurrence of postoperative nausea and vomiting for all patients, it did reduce the occurrence of these symptoms in patients who had a body mass index ≥25. It was also observed that muscular tissue oxygen saturation increases when blood pressure falls following the administration of nicardipine. These studies highlight the persistence of interest in understanding the value of tissue oximetry in patient care. Pulse oximetry and tissue oximetry are treated differently although neither monitor has robust evidence attesting to its outcome benefits. This difference may root in the difference in the physiology they monitor, the cost, the ease of use/interpretation/intervention and the relevance to patient safety and care quality. Pulse oxygen saturation represents a vital sign, whereas tissue oxygen saturation is likely a quality sign; however, further research endeavors are required to fully understand how to best use tissue oximetry.

The emerging role of pectoral nerve block (PECS block) in breast surgery: A case-matched analysis.

To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P<.001) acetaminophen (P=.02), morphine (P<.01), and nonsteroidal anti-inflammatory drugs (NSAIDS) (P<.01) was lower in the PECS group. Occurrence of postoperative nausea and vomiting (PONV) was lower in the PECS group (P=.04). On postoperative day 1, the use of acetaminophen (P=.23), morphine (P=.83), and NSAIDS (P=.4) did not differ. Twenty-one patients received surgery with PECS block plus sedation alone. PECS block can reduce intraoperative use of opioids and analgesic drugs, and is associated with reduced occurrence of PONV. Selected patients can receive breast-conserving surgery with PECS plus sedation, avoiding general anesthesia.

Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Rectus Sheath Block Combined with Butorphanol or Sufentanil for Single-Incision Laparoscopic Cholecystectomy: A Prospective, Randomized, Clinical Trial.

PurposePain after single-incision laparoscopic cholecystectomy (SILC), especially visceral pain, often troubles patients and doctors. Whether preemptive butorphanol can relieve visceral pain in patients undergoing SILC remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral rectus sheath block (RSB) and butorphanol for perioperative analgesia in patients undergoing SILC.Patients and MethodsFifty-eight patients who met the criteria were randomly divided into two groups, both of which were given preemptive RSB. Patients were given either butorphanol 0.02mg/kg (group B, n=29) or sufentanil 0.1 µg/kg (group S, n=29) as preemptive analgesia. The primary outcome was the cumulative frequency of rescue analgesic request within 24 hours after operation. Secondary outcomes were numeric rating scale (NRS) scores (from 0 to 10) of incisional pain and visceral pain, the length of hospital stay and the incidence of postoperative adverse events.ResultsThe frequency of postoperative rescue analgesic request of group S was significantly higher than that of group B (P=0.021). The NRS scores for visceral pain were lower in group B at 2, 6 and 12 hours after surgery than in group S (both P<0.001). The occurrence of postoperative nausea and vomiting (PONV) was significantly higher in group S. There were no significant differences between two groups for other outcomes.Conclusion Butorphanol can provide sufficient visceral pain treatment after SILC than the dose of sufentanil in equal analgesic effect.