PONV Score Research Articles

Impact of gasless vNOTES vs. traditional vNOTES on hemodynamic profiles and outcomes in patients with benign gynecological disease: study protocol of a randomized controlled trial

BackgroundLiterature regarding the advantages of gasless vNOTES is insufficient. The aim of our study is to compare gasless vNOTES vs. traditional vNOTES on hemodynamic profiles and outcomes in patients with benign gynecological disease. We hypothesize that compared with those in the traditional vNOTES group, hemodynamic profiles will be changed less during gasless vNOTES, while safety can be promised.MethodsThis is a single-center, prospective, single-blind, randomized controlled clinical trial, which has been approved by the Institutional Review Board of Chengdu Women’s and Children’s Hospital on September 27, 2022. One hundred and twenty patients will be recruited and randomly assigned to either the traditional vNOTES group or the gasless vNOTES group in a 1:1 ratio. For patients allocated to the traditional vNOTES group, after insertion of one port through the vagina, CO2 gas is infused with a pressure of 12–14 mmHg; while for those allocated to the gasless vNOTES group, a special device is used as an abdominal wall-lifting device to facilitate gasless surgery. CO2 pneumoperitoneum will not be used during the whole gasless vNOTES procedure. The primary outcome is vital signs at different time points. The secondary outcomes include surgical conversion rate, duration of surgery and anesthesia, anesthetic consumption, intraoperative estimated blood loss, VAS and PONV scores at postoperative 2 h and 24 h, administration of vasopressor drugs from the beginning of general anesthesia induction to 15 min after endotracheal intubation, including times, dosage, and type, intraoperative and postoperative complications, time of first getting out of bed after surgery, and time of first eating after surgery, including light drink.DiscussionThis is the first randomized controlled trial to compare the impacts of gasless vNOTES vs. traditional vNOTES on hemodynamic profiles and outcomes in patients with benign gynecological disease. If a favorable effect and safety of gasless vNOTES for hemodynamic profiles and outcomes in patients are shown, gasless vNOTES would be an optimal treatment option for patients with benign gynecological disease.Trial registrationThe trial was registered at https://www.chictr.org.cn/showproj.html?proj=182441 with registration No. ChiCTR2200064779 on Oct 17, 2022.

Comparison between the Apfel score and the Koivuranta score in predicting the occurrence of postoperative nausea and vomiting during general anesthesia

Abstract Background: PONV is one of the side effects that often occur after general anesthesia, occurs in the first 24 hours post surgery and occurs in as many as 30-70% of hospitalized patients. PONV greatly avoided by most patients and anesthesiologists. Recent risk score for prediction of PONV has been used as a way to classify patients according to risk prediction and provide prophylaxis in accordance with this classification. For everyday clinical purposes, a simple risk score in easy to do and shows the correlation between the predicted incidence of PONV in patients hospitalized. In the clinical practice known various risk score for prediction of PONV as Apfel scores, Koivuranta scores, Sinclair scores, Palazzo scores, Gan scores, and Scholz scores varying accuracy. Methods: The research design was a cohort study with the total of 80 patients recruited. Ordinal and nominal data was analyzed using chi-square test. P value < 0,05 was declared significant with 95% confidence level. Measurements taken are incidence of PONV between Apfel scores to Koivuranta scores with PONV scores. Results: Incidence of PONV in patients who carried the scoring with Apfel scores higher (80%) than Koivuranta scores, and statistically highly significant differences (p < 0,01). The results said that Apfel scores are more accurate than the Koivuranta scores, indicated by results of PONV scores positive (>1) on the Apfel scores 32 people (80%) and on the Koivuranta scores 12 people (30%), whereas PONV scores negative (≤ 1) on the Apfel scores 8 people (20%) and on the Koivuranta scores 28 people (70%). Conclusions: Apfel scores are more accurate than the Koivuranta scores in predicting the occurrence of PONV in patients with general anesthesia.

Acupressure Versus Ondansetron Usage for Postoperative Nausea and Vomiting After Gynecologic Surgeries.

Introduction Anti-emetic interventions include pharmacologic and non-pharmacologic strategies. Acupressure is a non-pharmacologic and non-invasive therapeutic method that involves applying physical pressure to acupuncture points with fingers or devices. The pericardium (PC6) acupoint is located on the palm side of the wrist between the palmaris longus and flexor carpi radialis tendons, three fingers across the wrist starting at the wrist crease. Our first aim was to assess the effect of PC6 point acupressure on PONV after gynecological surgeries compared to intravenous (IV) ondansetron. Secondly, we aimed to assess the factors associated with the firstand second hours (early) postoperative nausea scores. Methods This was a prospective, randomized, and single-centered intervention study conducted between November 1, 2022, and December 31, 2022, in a tertiary care hospital. Sancaktepe Martyr Prof. Dr. Ilhan Varank Education and Research Hospital Ethical Committee provided ethical approval for this study on October 14, 2022 (No: E-46059653-020). Randomization was done using the lottery method.Patients, who were over the age of 18with an American Society of Anesthesiologists (ASA) physical score of I, II, or III status and had undergone gynecologic surgery under general anesthesia, were included. Patients, who were ASAIV, under continuous use of opioids or corticoids, underwent surgery with regional anesthesia, or declined to participate in the study, were excluded.There were two comparisons in this study. First, we divided patients into two groups according to anti-emetic prevention. Patients, who received IV 4 mg ondansetron (Group O), and patients, who placed acupressure bands at the P6 points on both forearms (Group B). The second comparison was done to assess the factors associated with early postoperative nausea. Patients were divided into two groups according to the mean early postoperative nausea scores as low (< 4, Group 1) and high/moderate (≥ 4, Group 2).PONV and pain scores were collected at five-time points: the first, second, sixth, twelfth, and twenty-fourth hours after surgery. Results Of 102 patients, 50were in Group O and 52were in Group B. There was no significant difference in postoperative pain, nausea, and vomiting scores. Fifty patients (50%), including 24 patients (48%) in Group O and 26 patients (52%) in Group B, experienced early moderate/high postoperative nausea in our study. According to the second comparison, 52 patients were in Group 1, and 50 patients were in Group 2. Operation time; first and second-hour pain scores; first, second, sixth, twelfth, and twenty-fourth-hourscores; and first and second-hour vomiting scores were all significantly different across groups. Conclusion The effect of PC6 point acupressure on early PONV compared to IV ondansetron was similar after gynecological surgeries. However, using only one anti-emetic treatment did not adequately relieve early PONV. Of all patients, 11(10%) required an extra anti-emetic medication at the ward. 50% of patients experienced early moderate/high postoperative nausea in our study. Motion sickness history, operation time, and early postoperative pain scores were associated with early PONV.

Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial

BackgroundOpioids remain the mainstream therapy for post-surgical pain. The choice of opioids administered by patient-controlled intravenous analgesia (PCIA) for thoracoscopic lung surgery is unclear. This study compared 3 opioid analgesics for achieving satisfactory analgesia with minimal emesis (SAME).MethodsThis randomized clinical trial enrolled patients scheduled for thoracoscopic lung surgery randomized to receive 1 of 3 opioids for PCIA: oxycodone (group O), hydromorphone (group H), and sufentanil (group S). The primary outcome was the proportion of subjects achieving SAME, i.e., no-to-mild pain (pain score < 4/10) with minimal nausea/vomiting (PONV score < 2/4) when coughing during the pulmonary rehabilitation exercise in the first 3 postoperative days.ResultsOf 555 enrolled patients, 184 patients in group O, 186 in group H and 184 in group S were included in the final analysis. The primary outcome of SAME was significantly different among group O, H and S (41.3% vs 40.3% vs 29.9%, P = 0.043), but no difference was observed between pairwise group comparisons. Patients in groups O and H had lower pain scores when coughing on the second day after surgery than those in group S, both with mean differences of 1 (3(3,4) and 3(3,4) vs 4(3,4), P = 0.009 and 0.039, respectively). The PONV scores were comparable between three groups (P > 0.05). There were no differences in other opioid-related side effects, patient satisfaction score, and QoR-15 score among three groups.ConclusionsGiven clinically relevant benefits detected, PCIA with oxycodone or hydromorphone is superior to sufentanil for achieving SAME as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery.Trial registrationThis study was registered at (ChiCTR2100045614, 19/04/2021).

Transcutaneous Electrical Acupoint Stimulation Decreases the Incidence of Postoperative Nausea and Vomiting After Laparoscopic Non-gastrointestinal Surgery: A Multi-Center Randomized Controlled Trial.

ImportancePostoperative nausea and vomiting (PONV) gives patients a bad experience and negates their good recovery from surgery.ObjectiveThis trial aims to assess the preventive effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on the incidence of PONV in high-risk surgical patients.DesignThe large sample size, multicenter, evaluator-blinded, and randomized controlled study was conducted between September 3, 2019 to February 6, 2021.SettingThe 12 hospitals were from different Chinese provinces.ParticipantsAfter obtaining ethics approval and written informed consent, 1,655 patients with Apfel score ≥ 3 points were enrolled for selective laparoscopic non-gastrointestinal surgery under general anesthesia.InterventionsPatients were randomly allocated into the TEAS and Sham group with a 1:1 ratio. The TEAS group was stimulated on bilateral Neiguan and Zusanli acupoints after recovery from anesthesia on the surgical day and the next morning for 30 min, while the Sham group received an identical setting as TEAS but without currents delivered. Electronic patient self-reported scale was used to evaluate and record the occurrence of PONV.Main Outcomes and MeasuresPrimary clinical end point is the incidence of PONV which was defined as at least one incidence of nausea, retching, or vomiting after operation within postoperative 24 h.ResultsCompared with the Sham treatment, the TEAS lowered the PONV incidence by 4.8% (29.4 vs. 34.2%, P = 0.036) and vomiting incidence by 7.4% (10.4 vs. 17.8%, P < 0.001). TEAS also lowered persistent nausea incidence and PONV scores and decreased PONV related complications and Quality of Recovery−40 scores (P < 0.05). TEAS lowered the 24 h PONV risk by 20% (OR, 0.80, 95% CI, 0.65 −0.98; P = 0.032), and lowered hazard ratio by 17% (HR, 0.83, 95% CI, 0.70–0.99; P = 0.035). Both TEAS and palonosetron were the independent PONV risk protective factors for 24 h PONV incidence and cumulative PONV incidence. The combination of TEAS and palonosetron was the most effective strategy to reduce the PONV incidence (P < 0.001).Conclusions and RelevanceTEAS attenuated the PONV incidence and severity in high-risk surgical patients and may be applied clinically as a complement therapy to prevent PONV.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04043247, identifier: NCT04043247.

Effect of Postoperative High-Concentration Oxygen on Recovery After Thyroid Surgery: A Prospective, Open, Randomized, Controlled Study.

ObjectiveTo investigate the effectiveness of high-concentration oxygen on the improvement of throat symptoms and voice changes after thyroid surgery and its protection of the parathyroid function.MethodsA total of 600 patients undergoing thyroid surgery who met the inclusion criteria were randomly divided into the experimental group (n = 300) and the control group (n = 300) by using a random number generator. The patients in the experimental group underwent high-oxygen treatment [FiO280 (8 L/min)] for 6 continuous hours after returning to the ward after surgery. The patients in the control group underwent low-oxygen treatment [FiO230 (2 L/min)] for 6 continuous hours after returning to the ward after surgery.ResultsThe postoperative incision pain score of patients in the experimental group was significantly better than that in the control group at 6 h (1.07 ± 0.80 VS 1.23 ± 0.95, P=0.031) and 12 h (1.08 ± 0.64 VS 1.20 ± 0.73, P=0.041). The postoperative throat pain score of the patients in the experimental group was significantly better than that of the control group at 6 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.011) and 12 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.019). The PONV score of the patients in the experimental group was significantly better than that of the control group at 12 h (0.09 ± 0.19 VS 0.14 ± 0.37, P=0.024). The Voice Handicap Index score of the patients in the experimental group was significantly better than that of the control group at 24 h (2.89 ± 5.92 VS 4.10 ± 6.31, P=0.017), 36 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.035), and 48 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.032).ConclusionHigh-concentration oxygen can alleviate PONV and pain after thyroid surgery, with less severe voice changes potentially. However, its effects on swallowing function, and parathyroid function need to be further verified.Clinical Trial Registration NumberChiCTR-IOR-17012765 (China Clinical Trial Registry clinical trial registration center [http://www.chictr.org.cn/index.aspx)

Efficacy of orally disintegrating film vs intravenous ondansetron in preventing postoperative nausea and vomiting in middle ear surgeries under general anaesthesia

Introduction: Ondansetron is widely used perioperative antiemetic. In this study, we have assessed the anti-emetic efficacy of orally disintegrating film (ODF) in middle ear surgeries, associated with higher incidence of PONV. Materials and Methods: We studied two doses of ODF (4 and 8 mg) and compared it with IV ondansetron and placebo. All 120 cases were done under general anesthesia with standard anesthesia technique. Results: Oral intake was significantly delayed in placebo group. (p= 0.001) During first 6hrs, the PONV score was significantly low (p Conclusion: We conclude that all patients undergoing surgeries of middle ear should receive prophylactic antiemetic. Ondansetron in the form of orally disintegrating film is an effective as well as safe choice for PONV prevention in middle ear surgery with 8 mg to be the desired dose as compared to placebo and IV ondansetron. Keywords: Postoperative nausea vomiting, Ondansetron, Orally disintegrating film, Middle ear surgery.

Efficacy of Ultrasound Guided TAP Block with the Standard PostOperative Analgesic Regimen, In Providing Post-Operative Analgesia for Patients Undergoing Total Abdominal Hysterectomies

Introduction: A recent development in the treatment of post-operative pain is the use of peripheral nerve blocks. The technique involves blocking the conduction of nerve impulses by deposition of local anaesthetic around the nerve or nerves supplying the area of interest. Consequently, the sensory and/ or motor supply to the area supplied by the nerves, are effectively abolished, thus helping to achieve anaesthesia and analgesia. Methodology: The patients were selected by convenience sampling and those who matched the selection criterion, were briefed about the nature of the study and the procedures involved, in a language understood by them and written informed consent was taken. Descriptive data of the patient such as name, age, sex and detailed medical history, was collected. They were randomized into two groups with the help of computerized randomization software. Results: In our study it was noted that the mean total rescue analgesic consumption in patients belonging to Group S (over a period of 24 hours) was 73.3 mg. Whereas the mean total rescue analgesic consumption in Group T was only 35 mg. This difference in the mean total rescue analgesic consumption between the two groups was found to be statistically significant (p value &lt; 0.001). Conclusion: Patients in both Group T and Group S experienced some degree of nausea at the 2, 4 and 6 hour intervals, but the PONV scores of both the groups were comparable. Thereafter, patients in both the groups were asymptomatic.

Epidural Naloxone Attenuates Fentanyl Induced PONV in Patients Undergoing Lower Limb Orthopaedic Surgeries. a Prospective Randomized Double-Blind Comparative Study.

Background and aimEpidural administration of opioids with local anaesthetics is a popular choice for perioperative pain relief. But opioid induced side effects limit their use for postoperative analgesia. Hence, this study was designed to evaluate the effectiveness of epidural naloxone, an opioid receptor antagonist, in reducing PONV in patients receiving epidural fentanyl.MethodsAfter obtaining the Institutional Ethics Committee approval and written informed consent, 46 patients, between 18–80 years, of either sex, with ASA physical status 1–3, undergoing lower limb orthopaedic surgeries were enlisted for this prospective, randomized, double blind comparative study. Subjects were allocated to one of the two groups and received epidurally, either fentanyl with bupivacaine (Group C, n = 23) or fentanyl with bupivacaine and naloxone 2 mcg (Group N, n = 25), for reducing postoperative pain. PONV score and Wong Bakers Scale (WBS) for pain score were recorded at 6, 12 and 18hrs, postoperatively.ResultsAll patients were comparable with respect to age, gender, ASA PS, height, body weight as well as duration of surgery. A statistically significant decrease in PONV score was observed in Group N at 6 and 12 hours, postoperatively. The patients who required rescue antiemetic were also significantly lower in Group N at 6 and 12 hours. The mean WBS score for pain also showed significant reduction in Group N at 6 hours, postoperatively.ConclusionConcomitant use of low dose epidural naloxone and fentanyl is effective in attenuating PONV, besides enhancing analgesia in the earlypostoperative period.

Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study.

Background:The aim of this study is to understand the effect of ultrasound (US) guided erector spinae plane block (ESPB) in improving the intraoperative and postoperative analgesia in patients undergoing mastectomies, decreasing the use of opioids and in reducing postoperative nausea and vomiting.Methods:After local ethics committee approval, 100 patients were divided randomly into two groups. Group A with 50 patients received US guided ESPB with 30 ml of 0.25% of bupivacaine under US guidance. Group B with 50 patients received no block. Visual analogue scale (VAS) was used to assess pain postoperatively. All patients received 1 g intravenous intravenous paracetamol 8th hourly and morphine was used as rescue analgesia if VAS score is more than 4. Patients were monitored for VAS scores, postoperative nausea/ vomiting and total morphine consumption for a 24-hour period in a high dependency unit.Results:Postoperative morphine consumption was found to be significantly less in patients who received US-guided ESPB compared to control group (0.12 mg ± 0.59 mg in ESPB group compared to 1.70 ± 2.29 mg which was statistically significant, p=0.000). Only 3 patients in ESP group received rescue analgesia in the form of morphine whereas 22 patients in the control group received morphine. There was no difference in PONV score in either groups. There were no complications like vascular puncture, pneumothorax, or respiratory depression in both groups.Conclusion:US guided ESPB is quite effective in reducing perioperative pain in patients undergoing mastectomy. The trial was registered prospectively with CTRI with registration number: CTRI/2018/09/015668.

Electronically Recorded National Early Warning Scores, Pain Scores and PONV Scores Among Hospitalized Patients

Electronically Recorded National Early Warning Scores, Pain Scores and PONV Scores Among Hospitalized Patients

The effect of methadone on postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy: A prospective, randomized, double blinded, controlled clinical trial

Study objectivesThe aim of the present study was to assess the quality of recovery from anesthesia in patients undergoing laparoscopic cholecystectomy (LC) under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia by means of questionnaire Quality of Recovery-40 (QoR-40). DesignProspective Randomized Clinical Trial. SettingThe setting was at an operating room, postoperative recovery area and hospital ward. PatientsSeventy patients who underwent LC under remifentanil-based anesthesia were randomly assigned to receive methadone 0.1 mg kg−1 or morphine 0.1 mg kg−1. MeasurementsThe primary outcome was the quality of recovery, using the Quality of Recovery Questionnaire (QoR-40). Secondary outcomes included time to eye opening, the occurrence of nausea and vomiting, pain score, use of supplemental analgesics, and PACU length of stay. Main resultsNo differences were observed in the total or individual QoR-40 dimension scores. During the PACU stay, the occurrence of PONV and pain scores were similar between groups. Opioid consumption (p < 0.02) and the level of sedation (p < 0.01) were higher in the morphine group. There were no differences in the amount of time required to achieve PACU discharge criteria. The frequency of nausea or emesis, the severity of pain, and tramadol consumption were comparable between both groups while on the ward. ConclusionsPain scores and the Quality of Recovery did not differ between patients who underwent LC under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia.

Validation of simplified postoperative nausea and vomiting intensity scale in Taiwan.

This study determined whether the Simplified Postoperative Nausea and Vomiting Impact Scale (SPONVIS), could be used to predict clinically important PONV in Taiwanese. In this prospective, observational study, SPONVIS, simplified Apfel PONV Risk Scores, post-operative anti-emetic drug use, total PONV score, and 3-month recall score for PONV were recorded from Taiwanese patients who had undergone general anesthesia and surgery. With antiemetic use and 3-month recall score as validations of clinical significance, we determined whether the elements and cut-off points used in the original SPONVIS study could be used in Taiwanese patients. A total of 378 patients were included in the analysis. One hundred forty (37.1%) patients had PONV. Forty-eight patients (12.7%) had clinically important PONV (SPONVIS score ≥ 5). The odds ratios were 14.26 (CI 6.91-29.43; P < 0.001) and 4.95 (CI 2.42 to 10.11; P < 0.001), respectively, for prediction of anti-emetic drug use and 3-month recall. The SPONVIS and its construct elements were significantly related to anti-emetic drug use, 3-month recall score for PONV, total PONV score, and Apfel risk score (all P ≤ 0.005), results similar to those reported in the original Australian PONV impact score study. The SPONVIS cut-off points 3 and 5 were statistically significant predictors of anti-emetic drug use. However, a cut-off point of 3 had a higher OR (24.08) than a cut-off of 5 (14.26) for prediction of anti-emetic drug use. SPONVIS and both construct elements (the nausea and vomiting impact scores) are useful predictors of clinically important PONV in Taiwanese.

Study Of Efficacy Of Dexamethasone As Preemptive Analgesic In Patients Undergoing Total Abdominal Hysterectomy Under Spinal Anaesthesia: A Randomised Controlled Trial

Background: Dexamethasone is an analgesic and anti-emetic agent, that decreases analgesic consumption, yet improve post-operative analgesia. Objectives: To assess the effect of preemptive Dexamethasone on postoperative analgesia as primary objective. To assess the effect of preemptive Dexamethasone on occurrence of PONV and to study any immediate side effects of Dexamethasone if any as secondary objectives. Study Design: This is a randomized, double-blind, and placebo-controlled trial conducted over 120 patients undergoing total abdominal hysterectomy under subarachnoid block. Patients were randomized into three groups Group A - Inj. Dexamethasone 8 mg in 10 ml of Normal Saline preemptively + Inj Normal Saline 10 ml IV intraoperatively. Group B- Inj Normal Saline 10ml IV preemptively + Inj. Dexamethasone 8 mg in 10 ml Normal Saline IV intraoperatively. Group C- Inj Normal Saline 10ml IV preemptively + Inj Normal Saline 10ml IV intraoperatively (control group). Postoperatively, rest and activity pain scores, total analgesic and antiemetic consumption in 24 hours, PONV score , and side effects were recorded. Results: VAS scores at rest and movement, total analgesic dose required were higher in Groups B and C as compared to group A. Total analgesic dose required were significantly greater in Group B as compared to group A. PONV scores are comparable between group A and group B and significantly lower than control (C). No any immediate side effects observed. Conclusion: Preemptively Dexamethasone at a dose of 8 mg delays patient request for analgesia and reduces total analgesic consumption postoperatively without any side effects.

Efficacy of Preemptive oral pregabalin for prolonging post-operative analgesia in modified radical mastectomies

Background: The concept of preemptive analgesia had evolved in the recent years. Present days multimodal approach is the most preferred practice for perioperative pain relief, as no single agent is effective in inhibition of nociception without its side effects. Pregabalin originally a spasmolytic, now used as a newer anti-epileptic drug, in the management of generalized and partial epileptic seizures. Its use as a preemptive analgesic in many surgical procedures had proved promising results. Hence the aim of our study was to evaluate efficacy of preemptive pregabalin for prolonging post-operative analgesia, reducing post-operative opioid analgesic requirement and haemodynamic stability. Material and Methods: 80 patients of ASA grade I and II physical status posted for elective modified radical mastectomy were divided into 2 groups of 40 each. Group T –received pregabalin 150 mg orally 1 hour before general anaesthesia. Group C – received identical empty capsules as placebo 1 hour before general anaesthesia. Results: The postoperative VAS scores were significantly lower and duration of analgesia was longer in pregabalin group as to control group. The total analgesic consumption, PONV scores were also lower in pregabalin group. Ramsay sedation scores were slightly higher in pregabalin group but were acceptable clinically. The side effects were similar in both groups. Conclusion: Preemptive 150mg oral pregabalin reduces post-operative pain scores(VAS)significantly, provides longer duration and better quality of post-operative analgesia, reduces opioid analgesic requirement and attenuates haemodynamic response to laryngoscopy, endotracheal intubation and also extubation without increase the side effects when used in optimal doses. Keywords: Preemptive analgesia, Pregabalin, VAS scores, Hemodynamic stability, Modified radical mastectomies

Comparison of the preemptive analgesia of low dose ketamine versus magnesium sulfate on parturient undergoing cesarean section under general anesthesia

ObjectiveTo investigate the efficacy of the preemptive analgesic effect of low dose ketamine versus MgSO4 on potentiating postoperative analgesia when compared to placebo in patients undergoing cesarean section under general anesthesia.MethodsThis prospective randomized blind study included 60 parturient females scheduled for cesarean section under general anesthesia. They were randomized into three equal groups [20 patients each]: group I [Control]: received 20 ml normal saline 0.9%, group II [Ketamine]: received ketamine 0.3 mg/kg in 20 ml normal saline and group III [MgSO4]: received MgSO4, 30 mg/kg in 20 ml normal saline. Investigated medications infused over 10 min before induction of anesthesia. Fentanyl requirement, mean BP and HR were measured intraoperatively. Pain, sedation and nausea and vomiting were assessed at 2, 6, 12 and 24 h postoperatively. Total postoperative pethidine dose over 24 h was calculated.ResultsMBP and HR showed statistically significantly lower value in group (K) and (M) compared to group (C) at postintubation and postincision readings. Intraoperative fentanyl requirement was statistically higher in (C) groups compared to (K) and (M) groups. The time for first request for postoperative analgesia was longer and the total postoperative pethidine dose over 24 h was lower in (K) group compared to (C) and (M) groups. Postoperative VAS scores at 2 and 6 h postoperatively showed statistically highly significantly lower values in (K) group compared to (C) and (M) groups. Apgar, postoperative sedation and PONV scores showed no statistically significant differences among the three groups.ConclusionsPreemptive dose of either ketamine (0.3 mg/kg) or MgSO4 (30 mg/kg) in patients undergoing cesarean section under general anesthesia could suppress the pressor response to endotracheal intubation and skin incision and decreased the intraoperative fentanyl requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 6 h postoperatively.

Impact of the mode of hospitalisation on the postoperative complication rate after dissection tonsillectomy in children

ObjectivesTo compare postoperative complication rates after dissection tonsillectomy in patients operated by outpatient surgery and patients operated by inpatient surgery. Population and methodsA prospective, single-centre, observational study was conducted over a period of 1year. Dissection tonsillectomy was performed in 103 patients (mean age: 4years) between September 2011 and September 2012. The following parameters were studied: bleeding or inflammatory complication rate, readmissions, unscheduled visits, factors contraindicating outpatient surgery, reasons for failure of outpatient surgery and influence of Postoperative Nausea and Vomiting scores. ResultsTwo patient groups were composed: 54 patients were managed by outpatient surgery (Group O) and 49 patients were managed by inpatient surgery (Group I). The two main factors contraindicating outpatient surgery were age less than 3years (40%) and preoperative suspicion of sleep apnoea-hypopnoea syndrome (26%). Seven patients of Group O had to stay in hospital (outpatient failure rate of 13%). Postoperative complications were observed in 13% of patients of Group O versus 12.2% of patients of Group I with no statistically significant difference between the two groups. One patient in each group had to be readmitted; no statistically significant difference was observed between the two groups (P=0.41). PONV scores were very high (2) in all cases. ConclusionOutpatient tonsillectomy in well-selected patients is not associated with a higher postoperative complication rate than inpatient tonsillectomy. With systematic appropriate prophylaxis, Postoperative Nausea and Vomiting scores had no influence on the postoperative course.

Different Doses of Palonosetron for the Prevention of Postoperative Nausea and Vomiting in Children Undergoing Strabismus Surgery

Objective: The aim of this study was to evaluate the efficacy of different doses of palonosetron for the prevention of PONV in children undergoing strabismus surgery. Patients and Method: A total of 150 children who were classified with an American Society of Anesthesiologists physical status of I, were aged between 2 and 12 years, and were undergoing strabismus surgery under general anesthesia were enrolled in the study. A random numbers table was used to assign each child to receive palonosetron 0.5, 1.0, or 1.5 μg/kg (n = 50 in each group).All episodes of PONVat the intervals of 0–2, 2–6, 6–24, and 24–48 hours were evaluated using a numeric scoring system for PONV. A p-value of <0.05 was considered statistically significant. Results: The percentage of children with PONV during 0–48 hours after anesthesia was 24% with palonosetron 0.5 or 1.0 μg/kg, and 20% with palonosetron 1.5 μg/kg. There was no statistically significant difference between the study groups with respect to the number of children with PONV scores of 1, 2, or 3 during 0–48 hours after anesthesia. There was no statistically significant difference between the study groups with respect to the number of children with postoperative vomiting during all time periods after anesthesia. The percentage of children aged >6 years with postoperative nausea during 0–48 hours after anesthesia was 8.6%, 18.2%, and 15.4% with palonosetron 0.5, 1.0, or 1.5 μg/kg, respectively, but there was no statistically significant difference between the study groups. Conclusion: Palonosetron doses of 0.5, 1.0, and 1.5 μg/kg are recommended for further evaluation, as they appear to be the effective doses for the prevention of PONV following strabismus surgery in children.

The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy.

BackgroundThis randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy.MethodsEighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 µg/kg/min and a bolus of 0.375 µg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 µg/kg/min and a bolus of 0.225 µg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 µg/kg/min and a bolus of 0.1125 µg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 µg/kg/h and a bolus of 0.075 µg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected.ResultsThe groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R.ConclusionsThe additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

A comparison between intravenous paracetamol plus fentanyl and intravenous fentanyl alone for postoperative analgesia during laparoscopic cholecystectomy.

Purpose:our study compared the effect of fentanyl alone with fentanyl plus intravenous Paracetamol for analgesic efficacy, opioid sparing effects, and opioid-related side effects after laparoscopic cholecystectomy.Materials and Methods:eighty patients undergoing laparoscopic cholecystectomy were randomized into two groups, who were given either an IV placebo or an IV injection of 1g paracetamol just before induction. Both groups received fentanyl during induction and IM diclofenac for pain relief every 8 hourly for 24 h after surgery. The postoperative pain relief was evaluated by a visual analog scale (VAS) and consumption of fentanyl as rescue analgesic in the postoperative period for 24 h after surgery was measured. The incidence of PONV and sedation scores was also measured in the postoperative period.Results:the mean VAS score in first and second hour after surgery was less in the group receiving IV Paracetamol (3.3±0.4* vs. 5.2±0.9; 3.1±0.4* vs. 4.3±0.3); the fentanyl consumption over first 24 h was also less in the group receiving IV paracetamol (50±14.9 vs. 150±25.8). The time requirement of first dose of rescue analgesic in the postoperative period was also significantly prolonged in the group receiving IV paracetamol (76±24.7 vs. 48±15.8). There was no difference in the sedation scores and in the incidence of PONV in the two groups.Conclusion:The study demonstrates the usefulness of intravenous paracetamol as pre-emptive analgesic in the treatment of postoperative pain after laparoscopic cholecystectomy.