Postoperative Nausea And Vomiting In Group Research Articles

Perioperative Dexamethasone Split Between Two Doses Further Reduced Early Postoperative Nausea and Vomiting Than Single Dose Dexamethasone: A Randomized Blinded Placebo-Controlled Trial

ObjectiveWe investigated whether two perioperative doses of dexamethasone are more effective than a single dose in reducing early postoperative nausea and vomiting (PONV) during total knee arthroplasty (TKA). MethodsA total of 150 patients between June 1, 2021 and June 1, 2022 were randomized into three groups: two doses of normal saline (group A); a single dose of 10 mg dexamethasone before surgery and normal saline after surgery (group B); and two doses of 5 mg dexamethasone during the perioperative period (group C). Primary outcomes were incidences and severity of PONV within 24 hours after surgery; the number of patients requiring and the consumption of morphine and metoclopramine; and VAS scores for nausea and vomiting at 2, 4, 6, and 24 hours after surgery. Blood glucose levels on days 1, 2, and 3 after operation and incidences of surgical site infection (SSI) as well as gastrointestinal bleeding (GIB) within 45 days after operation were compared. ResultsWithin 24 hours after operation, the number of patients requiring and the amount of consumption of morphine and metoclopramide in groups B and C were significantly lower than those in group A, however, differences between groups B and C were insignificant (P > 0.05). Incidences and severity of PONV in groups B and C were significantly lower than those in group A, and differences between groups B and C were also significant (P < 0.05). At 2, 4, 6, and 24 hours after operation, there were significant differences in visual analogue scale (VAS) scores of PONV between groups A and B, A and C, as well as B and C. On postoperative days 1, 2, and 3, there were no significant differences in blood glucose levels among the groups, and there were no incidences of SSI or GIB in any group within 45 days after operation. ConclusionDexamethasone significantly reduces PONV within 24 hours after TKA, does not result in significant changes in postoperative blood glucose levels, and does not increase the risk of SSI as well as GIB. In addition, perioperative two-dose dexamethasone is more advantageous than single-dose dexamethasone in reducing PONV incidence and severity within 24 hours after TKA.

Effect of Intermittent Thoracic Paravertebral Block on Postoperative Nausea and Vomiting Following Thoracoscopic Radical Resection of the Lung Cancer: A Prospective Randomized Trial.

To explore the benefits of ultrasound-guided intermittent thoracic paravertebral block (TPVB) combined with intravenous analgesia (PCIA) in alleviating postoperative nausea and vomiting (PONV) during video-assisted thoracic surgery (VATS). 120 patients with lung carcinoma undergoing VATS were included and divided into three groups: group S (single TPVB+PCIA), group I (intermittent TPVB+PCIA), and group P (PCIA). The patients' NRS scores, postoperative hydromorphone hydrochloride consumption, and intramuscular injection of bucinnazine hydrochloride were recorded. The incidence of PONV and complications were documented. Compared with the group P, both group I and group S had significantly lower static NRS scores from 1-48 hours after the operation (P <0.05), and the dynamic NRS score of group I at the 1-48 hours after the operation were significantly decreased (P <0.05). Compared with the group P, the proportion of patients with PONV in group I was significantly lower (P <0.05), while there was no significant difference in group S. Moreover, the hospitalization period of patients in group I was significantly reduced compared with the other two groups (P <0.01), and the patient satisfaction was significantly increased compared with the group P (P <0.05). Intermittent TPVB combined with PCIA can reduce the postoperative pain and the occurrence of PONV.

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.

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

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

Optimization of analgesia algorithm in strabismus surgery in children: a single-center randomized controlled prospective study

INTRODUCTION. The postoperative period during strabismus surgery in children is often complicated by pain syndrome of different intensity and postoperative nausea and vomiting (PONV), which negatively affects postoperative rehabilitation. Intraoperative regional techniques have a sufficiently high analgesic profile, which serves as a justification for their use. Subtenon blockade refers to minimally invasive interventions. OBJECTIVES. To evaluate the efficacy of subtenone blockade for postoperative anesthesia of children after strabismus surgery. MATERIALS AND METHODS. A single-center open randomized controlled prospective longitudinal study was conducted in parallel groups. Group 1 — 36 patients, acetaminophen 1.5 mg/kg was used for postoperative anesthesia; Group 2 — 38 patients, a subtenon blockade was performed at the end of surgery. The main indicators of hemodynamics at the stages of the study, the level of cortisol and the redox coefficient, the level of pain and the frequency of PONV were taken into account. RESULTS. After surgery, patients reported of pain of different intensity 4 hours after surgery: Group 1 — 66.6 % of patients, Group 2 — 5.2 % of patients. PONV was present in 6 (16.6 %) patients of Group 1. There were no PONV in Group 2. The cortisol level in the group with subtenon blockade after 4 hours was 32 % lower (p ˂ 0.05) than in patients of the 1st group. In Group 2, the FORT/FORD coefficient significantly increased 4 hours after surgery from 0.45 ± 0.5 to 0.62 ± 0.2 (p ˂ 0.005). CONCLUSIONS. The use of subtenone blockade in strabismus surgery at the end of the operation allows to achieve pronounced and prolonged analgesia, to limit the manifestation of PONV in the postoperative period, as well as to limit the level of surgical stress in general, which in turn reduces the degree of inflammatory reaction of the eye.

Comparison of Palonosetron Versus Palonosetron and Dexamethasone for Prevention of Postoperative Nausea and Vomiting After Middle Ear Surgeries: A Randomized Controlled Study.

Background:Postoperative nausea and vomiting (PONV) are one of the common distressing conditions after anesthesia. The PONV are related to several potential risk factors are patient related, anesthesia related, and surgery related. In surgery-related risk, middle ear surgery is associated with a high incidence of PONV.Aims:This study aimed to compare the efficiency of palonosetron versus palonosetron with dexamethasone in the prevention of PONV in middle ear surgeries.Settings and Design:This was a prospective, randomized, double-blind study.Statistical Analysis:The data were presented as descriptive statistics for continuous variables and percentages for categorical variables and were subjected to Z-test/Chi-square test/Fisher's exact test. The value of P < 0.05 was considered statistically significant.Results:Demographic parts in comparison to age, duration of surgery, and duration of anesthesia were similar in both the groups. Our study showed that the incidence of PONV during 0–6 h was 38% (n = 19) in Group A and 12% (n = 6) in Group B and the incidence during 6–12 h postoperatively was 14% (n = 7) in Group A and 8% (n = 4) in Group B. During 12–24 h, the incidence was 8% (n = 4) and 6% (n = 3) in Group A and B, respectively. Hence, the difference of total early PONV in Group A was 60% (n = 30) and in Group B, it was 26% (n = 13) which was statistically significant (P < 0.03).Conclusions:The above result proves that palonosetron and dexamethasone group is superior in the prevention of PONV in middle ear surgery.

Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

BackgroundA few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia.MethodsA total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period.ResultsThe occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05).ConclusionsLidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia.Trial registrationClinicalTrials.gov (NCT03809923), registered on January 18, 2019.

English

BACKGROUND Ketamine and propofol are one of the commonly used drugs for induction of general anaesthesia. Ketofol, is the combination of ketamine and propofol in varying concentrations. Due to the paucity of information in the literature regarding comparison of different combinations of ketofol for use as an induction agent, we intend to study the various doses of propofol ketamine combination in view of its haemodynamic stability and its relevance to speed of induction as well as side effect profile. METHODS This is a double blinded randomised controlled trial study. 60 patients posted for elective surgery under general anaesthesia were selected. They were randomly allotted to three groups with 20 patients in each group. Group 1 received ketofol in the ratio of 1:1, group 2 in the ratio of 1:2, group 3 in the ratio of 1:3. The time from the start of injection till the loss of verbal command, induction time, was noted. Mean arterial pressure, incidence of apnoea, awareness, hallucinations and post-operative nausea and vomiting (PONV) were noted. RESULTS Induction time was fastest in group 3 followed by group 2 followed by group 1. It was statistically significant. Mean arterial pressure (MAP) was comparable in all the three groups at different time intervals except at 5 minutes after induction, the fall in group 3 was significant. The change in MAP as compared to baseline in group 1 and 2 in different time intervals was not significant. But the fall in MAP was significant as compared to baseline in all the different time intervals in group 3. There was no reported incidence of apnoea, awareness and hallucinations in all the three groups. There were two reported cases of PONV in group 1, one in group 2 and zero in group 3. CONCLUSIONS Ketofol with the maximum propofol and least ketamine combination has the fastest induction time. Ketofol in the combination of 1:1 and 1:2 offers more haemodynamic stability as compared to 1:3 combination and ketofol has minimal side effects. KEY WORDS Ketofol, Different Combinations, Induction Time, Haemodynamic Stability

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

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

Effects of menstrual cycle on nausea and vomiting after general anesthesia.

To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.

Effect of scheduled intravenous acetaminophen on postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery.

The aim of this study was to assess the effect of scheduled intravenous acetaminophen (SIVA) on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecologic surgery (LGS). This retrospective observational study identified consecutive patients who underwent LGS at our institution from January to November of 2017 and were managed with either our hospital's old protocol (Group H) or a new protocol using SIVA (Group S). Primary outcomes included the incidences of PONV and the amount of additional antiemetic required in the postoperative period. The secondary outcomes included the pain score on postoperative day 1, the requirement for additional analgesic medications, and the length of hospitalization (LOH). Patients in Group S had significantly lower incidences of PONV from postoperative days 0 to 1 and required significantly less antiemetics or tramadol than those in Group H (P = 0.0085). Patients at a low risk for PONV in Group S had significantly lower incidences of PONV than those in Group H (P = 0.0129). Further, the amount of additional tramadol required was lower in Group S than in Group H (P = 0.0021). Introduction of SIVA into the postoperative pain management protocol of LGS may reduce the incidence of PONV and the amount of adjunctive antiemetic medication required from postoperative days 0 to 1. In patients undergoing LGS, PONV prophylaxis using antiemetics should be prescribed depending on PONV risk profile; however, SIVA prophylaxis can be used in all patients regardless of PONV risk profile.

Comparing slow and rapid bolus of ephedrine in pregnant patients undergoing planned cesarean section under spinal anesthesia.

Background and Aims:While ephedrine was the preferred drug for treating spinal-induced hypotension in pregnancy, its use has declined because of resultant fetal acidosis. The objective of this randomized control trial was to compare the effects of a slow and rapid bolus of ephedrine on fetal acidosis, maternal blood pressure, and heart rate (HR) during cesarean section performed under spinal anesthesia.Material and Methods:Eighty full-term parturients scheduled for cesarean section under spinal anesthesia were randomly allocated into two groups. While both groups received 6 mg of ephedrine to treat hypotension, Group R (n = 40) received it as a rapid intravenous bolus and Group S (n = 40) received it slowly over 20 s with an infusion pump. The maternal vital parameters were recorded until delivery of the baby using a video camera. Umbilical cord blood was obtained using the three clamp method. Hemodynamic parameters, fetal acidosis, total number of ephedrine bolus used, peak HR after the ephedrine bolus, and occurrence of postoperative nausea and vomiting (PONV) were compared between the groups.Results:Mean increase in HR and blood pressure were significantly higher in Group R than the Group S after the first ephedrine bolus. Umbilical artery pH was significantly lower in Group R than in Group S (7.2 [6.8-7.3] vs. 7.3 [7.3-7.4], P < 0.01). A total number of ephedrine boluses were comparable in the two groups. 35% of the patients had PONV in Group R, whereas none had it in Group S (P < 0.01).Conclusion:Slow bolus of ephedrine is better than rapid bolus to treat spinal-induced hypotension during cesarean section in view of less fetal acidosis.

Day-Case Laparoscopic Cholecystectomy in Childhood: Outcomes from a Clinical Care Pathway

The aim of this study was to report clinical outcomes following the use of a pediatric day-case laparoscopic cholecystectomy (DCLC) clinical care pathway. The pathway was modified in September 2009 and we compare the clinical outcomes before and after this modification. A care pathway for DCLC was introduced in 2008 with emphasis on the day of admission, timing of surgery, choice of anesthetic agents, analgesia, postoperative feeding, mobilization, and pain scoring. Demographic and clinical data were recorded prospectively from January 2008 to January 2012. In September 2009, two modifications were made to the pathway. Induction of anesthesia was changed to total intravenous anesthesia, using propofol (target 4 to 6 µg/mL) and remifentanil (target 3 to 5 ng/mL) and the use of the gaseous anesthetic sevoflurane was eliminated with the aim of reducing the risk of postoperative nausea and vomiting (PONV). The postoperative feeding regime was changed from unrestricted to light diet for 72 hours. The rest of the pathway was unchanged. Data before (group 1) and following the modifications (group 2) were compared. We admitted 25 children with symptomatic cholelithiasis for DCLC under the care of one surgeon: 12 in group 1 and 13 in group 2. There were no significant differences in age between group 1 (median 13 [range 6 to 15] years) and group 2 (median 15 [9 to 16] years) (p = 0.07). There were no intra- or postoperative complications. The day-case rate increased from 6/12 (50%) in group 1 to 12/13 (92%) in group 2 (p = 0.03). The incidence of PONV reduced from 7/12 (58%) in group 1 to 0/13 in group 2 (p = 0.002). PONV in group 1 resulted in overnight stay (n = 6) and readmission (n = 1). One patient in group 2 had an overnight stay due to poor mobilization. Adoption of a DCLC pathway is feasible and safe for children. Emphasis on adequate pain management and avoidance of PONV results in a high rate of day-case surgery equivalent to that achieved in adult practice.

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

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

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

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

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

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

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

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

Nicotine Patch for the Prevention of Postoperative Nausea and Vomiting

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

RETRACTED: Inspired oxygen fraction of 0.8 compared with 0.4 does not further reduce postoperative nausea and vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy

Postoperative nausea and vomiting (PONV) is one of the most frequent complications after general anaesthesia. Single-dose antiemetic prophylaxis has limited efficacy in high-risk patients. Adding a simple potential antiemetic approach, such as increasing the inspired oxygen fraction, to the antiemetic portfolio would preserve pharmacological interventions for treatment of symptoms in the postoperative period. However, the antiemetic effect of a high inspired oxygen fraction is still discussed controversially. The aim of the study was to evaluate whether an inspired oxygen fraction of 0.8 decreases PONV in patients receiving the 5-HT3-antagonist dolasetron. In a randomized, placebo-controlled, double-blinded trial we studied 377 patients (ASA I-III) undergoing elective laparoscopic cholecystectomy. Induction of anaesthesia was standardized, including thiopental fentanyl and cis-atracurium. For all patients the individual risk for PONV was calculated using the Koivuranta score and all patients received 12.5 mg dolasetron i.v. before surgery. Patients were allocated randomly to one of three groups: Group A (n=125) received 80% oxygen in air, Group B (n=125) 40% oxygen in air and Group C (n=127) 40% oxygen in nitrous oxide. Postoperative nausea, postoperative vomiting (PV), or nausea, vomiting, or both (PONV) was assessed in the early (0-4 h) and overall postoperative period (0-24 h) by an anaesthesiologist unaware of patient allocation. There was a significantly lower incidence of PONV and PV in Groups A (PONV: 11.2%; PV: 3.2%) and B (PONV: 10.4%; PV: 3.2%) compared with Group C (PONV: 26.7%; PV: 13.3%), but there were no significant differences between Groups A and B. An inspired oxygen fraction of 0.8 does not further decrease PONV or vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy. The lower incidence of PONV in Groups A and B compared with Group C is most likely caused by the omission of nitrous oxide.

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

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