Postoperative Nausea And Vomiting Scores Research Articles

Efficacy and Safety of Paragastric Neural Blockade in Controlling Pain, Nausea, and Vomiting After Sleeve Gastrectomy: A Randomized Controlled Trial.

There are difficulties in controlling the symptoms of pain, nausea, and vomiting after laparoscopic sleeve gastrectomy (LSG). This study aimed to evaluate the efficacy and safety of PGNB on pain and nausea and vomiting in the early postoperative period in patients who underwent LSG. In this prospective, randomized, controlled, double-blind study, the patients were divided into two equally formed groups: patients who underwent PGNB after LSG and the control group. Postoperative pain symptoms were evaluated using the visual analog scale (VAS) scores, and nausea and vomiting symptoms were evaluated using the postoperative nausea and vomiting (PONV) scores. The study was completed with 90 patients, 45 patients in each group. The VAS scores measured at postoperative hours 1, 6, and 12 were statistically significantly lower in the PGNB group. There was no significant difference between the two groups in terms of the 24th hour VAS scores. The mean PONV scores of the PGNB and control groups were 0.47 ± 0.89 and 1.67 ± 1.95, respectively, revealing a significantly higher value for the controls. The mean time to first mobilization in the postoperative period was significantly shorter in the PGNB group. Upon the evaluation of patient satisfaction, it was determined that the satisfaction score of the PGNB group was significantly higher. PGNB is an effective and safe method for managing pain, nausea, and vomiting that occur in the early period after LSG.

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study.

Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient's height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0-6 h, 54/756 (7.1%); 6-24 h, 120/756 (15.9%); 24-48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24-48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6-24 h and 24-48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

Effect of Zusanli Acupoint Injection with Anisodamine on Postoperative Recovery Quality of Patients Undergoing Bariatric Surgery

PurposeTo evaluate the influence of anisodamine injection at the Zusanli (ST36) on early postoperative recovery quality in patients who have undergone laparoscopic sleeve gastrectomy.Materials and Methods141 patients undergoing laparoscopic sleeve gastrectomy were randomly divided into the control group (group C), the normal saline group (group S) and the anisodamine group (group A). Acupuncture point injections were administered after induction of general anesthesia. The quality of recovery-40 questionnaire (QoR-40) scores were documented preoperatively (D0) and on the 1st (D1), 3rd (D3) and 7th (D7) days postoperatively. Additional metrics included: the numerical rating scale (NRS) for pain, postoperative nausea and vomiting (PONV), assessment and analgesic consumption 24-h post-extubation and the initial postoperative times for ambulation and anal exhaust. Substance P (SP), β-endorphin (β-EP), motilin (MTL) and gastrin (GAS) were quantified at 24-h post-surgery.ResultsCompared with group C, group A demonstrated an elevation in QoR-40 scores and physical comfort dimensions during D1-3, and an increased pain scores during D1-7; group S exhibited an augmentation in QoR-40 scores and pain scores on D1 (p < 0.05). Compared with group S, group A improved QoR-40 scores on D1 and pain scores during D1-3 (p < 0.05). SP, β-EP, MTL and GAS presented significant variances among the groups 24-h post-surgery (p < 0.05). There were significant differences between the groups in NRS pain scores and PONV scores at 24-h postoperatively, dosage of dizocin on the first postoperative day, and time to first anal defecation (p < 0.05).ConclusionThe administration of anisodamine via ST36 acupoint injections has been demonstrated to facilitate the recuperation of gastrointestinal functionality, to alleviate postoperative pain and nausea, and substantially to enhance the quality of early postoperative recovery.Graphical

Use of a Combination Lavender/Peppermint Aromatherapy Patch During Port Catheter Placement Under Monitored Anesthesia Care Does Not Reduce Time to Discharge Readiness: A Randomized Controlled Trial.

Background: Intraoperative anxiety is a common problem when Monitored Anesthesia Care (MAC) is used instead of general anesthesia during minor surgical procedures such as port catheter placement. Nonpharmacological anxiolytics such as aromatherapy have been studied for their effects on preoperative anxiety, but no placebo-controlled study of aromatherapy during surgeries under MAC has yet been performed. Methods: After IRB approval, 70 patients were randomized 1:1 to receive either a lavender/peppermint aromatherapy patch (Elequil Aromatabs®; Beekley Corporation) or a matching placebo patch. The primary outcome, time to readiness for discharge from postoperative acute care units (PACU; min), was assessed every 15 min until a modified postanesthesia recovery score for ambulatory patients (PARSAP) score of 18 or higher was reached. In the preoperative holding area, the assigned patch/placebo was activated and affixed to a folded towel placed aside the subject's head, contralateral to the side of the planned surgery. The towel and patch/placebo were discarded when the subject left the operating room (OR). Results: No difference was found between the treatment and placebo groups on the primary outcome of time to discharge readiness (mean [standard deviation, SD]: 82 [15] vs. 89 [21] min, respectively, p = 0.131). No difference was found between the treatment and placebo groups on the secondary outcomes of intraoperative midazolam dose, intraoperative opioid dose, intraoperative ondansetron dose, or intraoperative promethazine dose. No difference was found between the treatment and placebo groups in the proportion of subjects requiring rescue postoperative nausea and vomiting (PONV) medication in the PACU or the proportion of subjects requiring opioids in the PACU. No difference was found between the treatment and placebo groups in pain intensity in PACU, average PONV score in PACU, or patient satisfaction in PACU. PACU patient satisfaction was high for both the patch and placebo groups (35/35 [100%] vs. 32/34 [94%] "very satisfied," p = 0.239). Conclusions: Aromatherapy treatment is not indicated intraoperatively to reduce anxiety or the use of antiemetics in patients requiring Port catheter placement. Trial registration: Clinicaltrials.gov, identifier: NCT05328973.

Study of the effect of timing of pre-operative administration of dexamethasone and ondansetron on post-operative nausea and vomiting follow laparoscopic cholecystectomy: A prospective randomized control trial

: Post-operative nausea and vomiting (PONV) is potential complication in patients after laparoscopic cholecystectomy. The incidence rate of PONV after laparoscopic cholecystectomy (LC) is 46-75% which is higher than that after other types of surgery. The present study was aimed to compare the effect of timing of dexamethasone and ondansetron alone when given 45 minutes before induction or given just before induction of anaesthesia for control of PONV in laparoscopic cholecystectomy. : Tocompare the effect of timing of dexamethasone and ondansetron each when given 45 minutes before induction or given just before induction for control of PONV in laparoscopic cholecystectomy.: After approval by the institutional ethics committee, this study was carried out on 200 patients of both sexes in the age group of 20-60 years. It was a randomized controlled trial. And after obtaining the consent, the patients were allocated in four groups randomly. Group A: 8 mg dexamethasone 45 minutes before induction, Group B: 4 mg ondansetron 45 minutes before induction, Group C: 8 mg dexamethasone just before induction and Group D:4 mg ondansetron just before induction. Patients were observed for 24 hours after surgery for any episode of nausea and vomiting for 24 hours. Patient satisfaction with the management of PONV symptoms using 10 points verbal rating scale was accessed (VRS, 0=not satisfied, 10 = fully satisfied).: Incidence of nausea and vomiting was significantly higher in group B was 68% and D 50% in comparison to group A 28%and C 36% (P=0.003). PONV score was highly significant when ondansetron was administered 45 minutes before induction as compare to dexamethasone when administered 45minutes before induction. The effect of ondansetron was also significant in PONV score of 24 hrs in comparison to dexamethasone.: The ondansetron appears to have a shorter duration of action in comparison to dexamethasone. Timing of administration of ondansetron is important in laparoscopic cholecystectomy before surgery as it has bearing on the incidence of vomiting and rescue antiemetic required. It was found that administration of ondansetron just before induction still delays the onset of PONV in comparison to when given 45 minutes before induction.

Prevention of Postoperative Nausea and Vomiting after Abdominal Surgery : Aprepitant/Dexamethasone Versus Mirtazapine/Dexamethasone

Background: Patients having elective abdominal surgery under general anesthesia often have Postoperative Nausea and Vomiting (PONV). In this study the main goal is to evaluate the outcome of Aprepitant/Dexamethasone (A/D) combination vs Mirtazapine/Dexamethasone (M/D) combination vs Dexamethasone (D) alone for prevention of PONV in individuals after abdominal surgery. Materials and methods: This cross sectional study was carried out at tertiary medical hospital from January 2021 to January 2022. Where a total of 150 patients scheduled for abdominal surgery were randomly allocated to receive 8 mg dexamethasone Intravenous Infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. In each 50 patients divided to each group. Assessment of PONV was carried out at 0–2 h (Early) and 2–24 h (Late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes. Results: Majority of the study populations belonging to 41-50 years age group (65%) and 60% of them were male. In concordance to that, the intraoperative variables of duration of surgery and mean given intravascular fluid volume were comparable between groups. In the early postoperative period (0–2 h), there was a statistically significant difference between the A/D group and the D group in the number of vomiting episodes with comparable efficacy between the A/D and M/D groups. There were no statistically significant differences between the studied groups regarding nausea episodes, collective PONV, rescue antiemetic usage, and the number of patients exhibiting a complete response. Pain score at (0–2 h) was significantly higher in the D group in comparison to the A/D and M/D groups with comparable efficacy between the A/D and M/D groups (p &lt; 0.001). The rescue analgesic doses were significantly higher in the D group compared to the A/D and M/D groups with statistically significant differences between the A/D and M/D groups (p &lt; 0.001). in addition, more patients in the A/D and M/D groups were satisfied with the PONV prevention protocol compared to the D group. Conclusion: The combination of aprepitant and dexamethasone, as well as mirtazapine and dexamethasone, has been proven to be more effective than dexamethasone alone in reducing postoperative nausea and vomiting in critically ill patients following abdominal surgery. IAHS Medical Journal Vol 5(2), Dec 2022; 29-33

The risk factors of postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy and laparoscopic distal gastrectomy: a propensity score matching analysis

Postoperative nausea and vomiting (PONV) is a common side effect after laparoscopic surgery. The aim of the study is to investigate the variables that could predict PONV in patients who underwent laparoscopic gastrectomy. We divided patients who underwent laparoscopic gastrectomy into PONV and No-PONV groups. Propensity score matching (PSM) was applied to adjust confounding factors for further validation, and ordinal logistic regression analysis was used to identify predictors for PONV. In the ordinal logistic regression analysis, the preoperative neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]: 3.19, 95% confidence interval [CI]: 1.38–7.38; p < 0.01) was identified as an independent risk factor for the presence of PONV and a predictor of the severity of PONV (OR: 3.44, 95% CI: 1.67–5.20; p < 0.01) in 94 PSM patients. Besides, NLR was positively correlated with the PONV score (r = 0.534, p < 0.001). In the receiver-operating characteristic (ROC) curve analysis, an NLR with an optimal cutoff value of 1.59 predicted severe PONV with a sensitivity of 72% and specificity of 81%. The NLR was an independent risk factor for the presence of PONV, and a high NLR tends to be positively associated with the severity of PONV after laparoscopic gastrectomy.

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

BackgroundBariatric surgery depends on the development of novel anesthetic techniques to reduce the incidence of complications and improve postoperative outcomes. Ketamine and dexmedetomidine have been used for perioperative analgesia and we hypothesized that they would decrease postoperative morphine requirements. The objective of this trial is to study whether choice of ketamine or dexmedetomidine infusion would affect postoperative total morphine consumption.MethodsNinety patients were equally randomized into three groups. The ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min, followed by an infusion of the same drug (0.3 mg/kg/h). The dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min, followed by an infusion of this drug (0.5 mg/kg/h). The control group received a saline infusion. All infusions were given till 10 min before the end of surgeries. Intraoperative fentanyl was given when patient developed hypertension and tachycardia despite adequate anesthesia and muscle relaxation. Postoperative pain was managed by a rescue dose of 4 mg of IV morphine, with a minimum interval of 6 h between morphine doses if the numerical rating scale (NRS) score was ≥ 4. The primary outcome was the total morphine dose, and the secondary outcomes were intraoperative fentanyl requirement, time to extubation, postoperative nausea and vomiting (PONV), NRS scores, and modified observer’s agitation/sedation scale (MOASS) scores.ResultsCompared with ketamine, dexmedetomidine decreased the need for fentanyl intraoperatively (160 ± 42 µg), shortened the time to extubation (3 ± 1 min), and improved MOASS and PONV scores. In turn, ketamine decreased postoperative NRS scores and the need for morphine (3 ± 3 mg).ConclusionsDexmedetomidine treatment was associated with lower fentanyl doses, a shorter time to extubation, and better MOASS and PONV scores. Ketamine treatment was associated with significantly lower NRS scores and morphine doses. These results indicated that dexmedetomidine effectively decreased intraoperative fentanyl requirement and the time to extubation, while ketamine decreased the need for morphine.Trial registrationThis trail was registered on the clinicaltrials.gov registry (NCT04576975) on October 6, 2020.

Effectiveness of Ondansetron with a combination of Curcuma xanthorrhiza and Kleinhovia hospita against Post-Operative Nausea and Vomiting (PONV) after Laparotomy surgery

The study aimed to analyze differences in the effectiveness of ondansetron administration compared to the administration of ondansetron and the combination of Curcuma xanthorriza and Kleinhovia hospita against the incidence of PONV at Dr. Moewardi Hospital. Thirty patients with the physical status of the American Society of Anesthesiologists (ASA) I or II who underwent laparotomy surgery were randomly premedicated by double-blinded method in each group: the control group, namely premedication of 8 mg ondansetron per oral, and the treatment group, namely premedication of capsule combination of ondansetron 8 mg and Curcuma xanthorriza and Kleinhovia hospita 1 gr. PONV was assessed using PONV score assessment. PONV assessment was carried out 2 hours post-operation. PONV scores between the control group and the treatment group was found significant (p = 0.017). There was no significant difference (p &gt; 0.05) in other variables such as age, weight, height, body mass index, and duration of surgery. Risk factors such as gender and smoking history were obtained PONV scores with insignificant differences (consecutive p values = 0.625; 0.527). Premedication of a combination of ondansetron and Curcuma xanthorriza and Kleinhovia hospita in this study proved more effective in reducing PONV scores.

Effect of Acupuncture on Postoperative Pain in Patients after Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

To evaluate the efficacy and safety of acupuncture compared to that of parecoxib sodium on postoperative pain (POP), postoperative nausea and vomiting (PONV), and the Bruggemann Comfort Scale (BCS) in patients following laparoscopic cholecystectomy (LC). Eligible patients admitted to the hospital for LC were randomly allocated to either acupuncture or control groups in a 1 : 1 ratio. The subjects in the acupuncture group received acupuncture while those in the control group were injected by parecoxib sodium at their requests. The pain score, PONV score, and BCS were assessed at 0 h, 6 h, 9 h, and 12 h after operation. The primary outcome was the pain score. The secondary outcomes included the number of patients asking for parecoxib sodium from the two groups at 0-6 h and 6-12 h, PONV score, and BCS score. The pain score of the acupuncture group were lower in acupuncture than that in the control group at 6 h and 9 h after operation (P=0.002, P=0.008). However, no difference was found at 12 h. Besides, the number of patients administered parecoxib sodium in acupuncture group was less than that in the control group both at 0-6 h and 6-12 h after operation (P=0.019, P < 0.001). Similarly, there were significantly lower levels of PONV score and higher levels of BCS at 6 h after operation in the acupuncture group than in the control group. However, no difference was found at 9 h and 12 h. Acupuncture can clinically improve the short-term treatment of postoperative pain after LC and reduce the request for extra analgesics; therefore, acupuncture might be a potential method as one of multimodal analgesia techniques to treat POP following LC. Trial Registrations. This trial is registered with ChiCTR2000036885 (Chinese Clinical Trial Registry).

Dexmedetomidine versus Clonidine for Improved Quality of Emergence from General Anaesthesia: A Randomised Placebo-Controlled Study

Introduction: Extubation of the trachea upon emergence from General Anaesthesia (GA) is often accompanied by potentially dangerous events, like coughing, hypertension, tachycardia, and agitation. The centrally acting a -2 agonist, dexmedetomidine, has been evaluated to attenuate the emergence/extubation response. However, there is insufficient evidence regarding the effectiveness of clonidine for the same purpose. Aim: This study aimed to evaluate the quality of emergence from GA in patients receiving clonidine infusion versus dexmedetomidine infusion. Materials and Methods: In this randomised, double-blinded trial conducted over a period of 5 months, 105 patients aged 18-70 years, of either sex, with American Society of Anaesthesiologists (ASA) grade I-III, scheduled for elective laparotomies with an estimated duration of 1-4 hours, were randomly assigned to groups D, C, and P. Group D received inj. dexmedetomidine 1 μg/kg, group C received clonidine 3 μg/kg, and group P received placebo (normal saline) via intravenous (i.v.) route over 10 minutes using a syringe pump, 10 minutes prior to the anticipated end of surgery. Haemodynamic parameters, cough, agitation, shivering, time to extubation, sedation, Visual Analogue Score (VAS), and Postoperative Nausea and Vomiting (PONV) scores were recorded before, during, and after extubation. The incidence of complications (hypotension, bradycardia, or others) was also recorded. Categorical data were expressed as proportions, while numerical data were presented as mean±Standard Deviation (SD) or median±Interquartile Range (IQR). Appropriate data were compared using Statistical Package for Social Sciences (SPSS) version 16.0. Results: A total of 105 patients were included, with 53 males and 52 females. There was no difference in the demographic characteristics, such as age, gender, and Body Mass Index (BMI), amongst the three groups. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)) were significantly lower in patients of group D and group C compared to the placebo group at 5, 10, 10, and 15 minutes, respectively, after the beginning of drug infusion (p-value &lt;0.05). Patients in groups D and C had significantly lower median cough scores at 20-25 minutes compared to the placebo group (p-value at 20 and 25 minutes was 0.012 and &lt;0.001, respectively). There was a significant reduction in postoperative pain, as measured by VAS score, and an increase in sedation, as measured by Ramsay sedation score, in groups D and C compared to the placebo group. There was no statistical difference in agitation score, shivering score, PONV score, time to extubation, and incidence of complications among the three groups (p-value &gt;0.05). Conclusion: Administration of 1 μg/kg of dexmedetomidine or 3 μg/kg of clonidine over 10 minutes prior to recovery from General Endotracheal Tube Anaesthesia (GETA) results in a better quality of recovery, as evidenced by a statistically significant reduction in cough scores in patients undergoing elective laparotomies when compared to patients of placebo group.

Interest of pharyngeal packing in head and neck surgery: a meta-analysis

Introduction: There is controversy regarding the use of pharyngeal packing in oral and nasal surgery. The primary objective of this study was to examine the association between pharyngeal packing, throat pain, and postoperative nausea and vomiting (PONV) in head and neck surgery. Material and methods: A systematic review of clinical studies published from January 2000 to August 2020 concerning the use of pharyngeal packing in head and neck surgery was conducted in the Medline, ScienceDirect and Cochrane Library databases. Throat pain and PONV were collected in each article, and a meta-analysis was performed. Results: A total of 10 clinical trials involving 877 patients were included in the meta-analysis. Pharyngeal packing did not significantly decrease PONV score either during the immediate (OR = 0.90, 95% CI: 0.59 to 1.38, p = 0.52, I2 = 0%) or the delayed postoperative period (OR = 0.88, 95% CI: 0.54 to 1.43, p = 0.28, I2 = 21%), but significantly increased the immediate postoperative throat pain score (MD = 0.68, 95% CI: 0.21 to 1.16, p = 0.19, I2 = 35%). Conclusion: This study suggests that the use of a pharyngeal packing to improve the preoperative aftermath in head and neck surgery should not be recommended.

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study.

Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30- and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

Preventing nausea and vomiting after gynecological laparoscopic surgery by patient-controlled intravenous analgesia with a naloxone admixture: A randomized controlled trial.

Background:Opioid-induced nausea and vomiting are common side effects of patient-controlled intravenous analgesia (PCIA). This study aimed to explore the inhibitory effect of a naloxone admixture on the incidence of sufentanil-induced postoperative nausea and vomiting (PONV).Methods:A total of 132 Uyghur American Society of Anesthesiologists I and II patients scheduled to undergo elective gynecological laparoscopic surgery were recruited; among these, 120 patients were enrolled and randomly allocated into 4 groups: patients receiving PCIA but no naloxone were included in the control group (group A); patients receiving PCIA with a low-dose naloxone admixture at 0.2 μg·kg−1·h−1 were included in group B; patients receiving PCIA with naloxone admixture at 0.4 μg·kg−1·h−1 were included in group C; patients receiving PCIA with naloxone admixture at 0.6 μg·kg−1·h−1 were included in group D. All patients were administered sufentanil at 0.04 kg−1·h−1, butorphanol at 2 kg−1·h−1, and dexmedetomidine at 0.08 kg−1·h−1 using a PCIA device within 2 days of surgery. The occurrence of nausea and vomiting, visual analogue scores for pain intensity, mean arterial pressure, heart rate, oxygen saturation, pruritus, lethargy, respiratory depression, etc, was recorded at 2, 8, 12, 24, and 48 hours postoperatively.Results:There was a significant difference in the PONV scores between the groups at 8, 12, and 24 hours after surgery (P < 0.01). At 8 and 12 hours, the score of group C/D was significantly lower than that of group A/B (P < 0.01). At 24 hours after surgery, the PONV score of group B/C/D was significantly lower than that of group A (P < 0.01). No significant difference was observed in the general data and visual analogue scores for postoperative pain between the 4 groups.Conclusion:Naloxone admixture administered at 0.4 to 0.6 μg·kg−1·h−1 can exert an effective inhibitory effect on the incidence and intensity of PONV in gynecological laparoscopic surgery.

A Comparative Study of Palonosetron with Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting (PONV) Following Laparoscopic Gynaecological Surgeries.

Incidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70-80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing gynaecological laparoscopic surgery. In this randomised, controlled, double-blind trial, nonsmoking females 18-70 years and weighing 40-90 kg, scheduled for elective laparoscopic gynaecological surgeries, were enrolled into the ondansetron (Group A, n=65) or palonosetron (Group B, n=65) group. Palonosetron (1 mcg/kg 4) or ondansetron (0.1 mg/kg 4) were administered just before induction. Postoperatively, incidence of nausea, vomiting, PONV (scored on a scale of 0-3), need for rescue antiemetic, complete response, patient satisfaction, and adverse effects were evaluated for up to 48 h following surgery. The overall PONV scores and postoperative nausea score during 0-2 h and 24-48 h were comparable, but PONV scores (P=0.023) and postoperative nausea scores (P=0.010) during 2-24 h were significantly lesser in Group B compared to Group A. There was no statistically significant difference in the postoperative vomiting score or retching during 0-48 h. The amount of first-line rescue antiemetic used during 2-24 h was significantly higher in Group A (56%) than in Group B (31%) (P=0.012; P<0.05). Complete response to the drug during 2-24 h was significantly higher (P=0.023) in Group B (63%) compared to Group A (40%), whereas response was comparable during 0-2 h and 24-48 h. Both groups had comparable incidences of adverse effects and patient satisfaction scores. Palonosetron has superior antinausea effect, less need of rescue antiemetics, and lesser incidence of total PONV in comparison to ondansetron during 2-24 h and comparable effect to ondansetron during the 0-2 h and 24-48 h postoperative periods in high-risk patients undergoing gynaecological laparoscopic surgery.

Effects of Sugammadex and Neostigmine on Post-operative Nausea and Vomiting in ENT Surgery.

We aim to compare the effects of sugammadex on postoperative nausea and vomiting (PONV) with those of neostigmine–atropine mixture. A total of 136 American Society of Anesthesiology (ASA) I or II patients, aged 18 to 65 years who underwent ear, nose, and throat (ENT) surgery under general anesthesia, were recruited in this prospective, randomized, double-blind study to receive either sugammadex 2 mg/kg or neostigmine 2.5 mg with atropine 1 mg for reversal of neuromuscular blockade. PONV scores and the need for the rescue of anti-emetic were assessed upon arrival in the post-anesthesia recovery unit and at 1-, 6-, 12-, and 24-h post-reversal. The incidence of PONV was significantly lower in patients who received sugammadex (3%) compared to patients who received neostigmine–atropine mixture (20%) at 6 h postoperative (p = 0.013). The incidence of PONV was comparable at other time intervals. None of the sugammadex recipients require rescue antiemetic whereas two patients from the neostigmine–atropine group required rescue antiemetic at 1 and 6 h post-reversal, respectively. The need for the rescue antiemetic was not statistically significant. We concluded that reversal of neuromuscular blockade with sugammadex showed lower incidence of PONV compared to neostigmine–atropine combination in the first 6 h post-reversal.

A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone.

Background Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG. Methods Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0–2 h (early) and 2–24 h (late). The primary outcome was the complete response 0‐24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes. Results The A/D and M/D groups were superior to the D group for a complete response within 0–24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0–24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2–24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2–24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001). Conclusion Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.

Comparison of two different anesthesia methods on the quality of surgical condition in transvaginal natural-orifice transluminal endoscopic surgery (vNOTES): A prospective single-blind randomized clinical trial

BackgroundThe purpose of the current study is to compare the quality of surgical condition of combined epidural-general anesthesia (EGA) versus general anesthesia (GA) in patients undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES). MethodsPatients undergoing vNOTES were randomly allocated to receive GA or EGA. The primary outcome was evaluate the quality of surgical condition. We further assessed patients’ medical data regarding the need and consumption of intraoperative analgesics and vasoactive drugs. The visual analogue scale (VAS) and postoperative nausea and vomiting (PONV) scores were assessed at 2 h and 24 h postoperatively. We have registered the number of patients who needed rescue analgesics and antiemetics within 24 h after surgery. ResultsThe scores of the quality of surgical condition was 1.9 ± 0.8 in the GA group and 1.4 ± 0.7 (P = 0.001) in the EGA group. The PONV scores were not significantly different in the first two 2 h following surgery between the groups. The obviously differences in the PONV scores between the EGA group and GA group were detected at the 24th postoperatively. Moreover, there were no significant differences in the consumption of atropine, sufentanil, cisatracurium, propofol, sevoflurane and neostigmine between the two groups. Regarding the duration of extubated time, operative time, duration of anesthesia time and postoperative length of hospital stay (PLOS), our findings did not showcase significant differences between the two groups. Similarly, we did not detect significant changes in the postoperative pain at the two time points between the groups. ConclusionOur results showed that compared with GA, EGA improved the quality of surgical condition in patients undergoing vNOTES. As epidural block is an additional invasive procedure with its attendant risks, we should weigh the pros and cons when combined epidural-general anesthesia is used for vNOTES in the future. Trial registrationThis study was registered at Chinese Clinical Trial Registry chictr.org.cn (http://www.chictr.org.cn/) with No. 2000032406 on April 27, 2020.

A Randomised Study To Compare Palonosetron With Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting (PONV) Following Laparoscopic Gynecological Surgeries.

BackgroundIncidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70-80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing gynecological laparoscopic surgery.MethodologyIn this randomized, controlled, double-blind trial, non-smoking females aged 18-70 years, weighing 40-90 kg, and posted for elective laparoscopic gynecological surgeries were enrolled into ondansetron (Group A, n = 65) and palonosetron (Group B, n = 65) groups. Palonosetron (1 mcg/kg IV) or ondansetron (0.1 mg/kg IV) were administered just before induction. Postoperatively, the incidence of nausea, vomiting, PONV (scored on a scale of 0-3), need for rescue antiemetic, complete response, patient satisfaction, and adverse effects were evaluated up to 48 h following surgery. Normally distributed continuous variables were compared using Student’s t-test. In addition, the Chi-squared test or Fisher’s exact test were used to compare nominal categorical data as deemed appropriate. P-value <0.05 was observed as statistically significant.ResultsThe overall PONV scores and postoperative nausea scores during 0-2 and 24-48 hours were comparable, but PONV scores (p = 0.023) and postoperative nausea scores (p = 0.010) during 2-24 hours were significantly lesser in Group B compared to Group A. There was no statistically significant difference in the postoperative vomiting score or retching during 0-48 hours. The amount of first-line rescue antiemetic used during 2-24 hours was significantly higher in Group A (56%) than in Group B (31%) (p = 0.012; p <0.05). A complete response to the drug during 2-24 hours was significantly higher (p = 0.023) in Group B (63%) compared to Group A (40%), whereas response was comparable during 0-2 and 24-48 hours. Both groups had a comparable incidence of adverse effects and patient satisfaction scores.ConclusionPalonosetron has a superior anti-nausea effect, less need for rescue antiemetics, and lesser incidence of total PONV compared to ondansetron during 2-24h and comparable effect to ondansetron during 0-2h and 24-48h postoperative period in high-risk patients undergoing gynecological laparoscopic surgery.

Abstract No. : ABS3199: Comparison of self-selected music and prefixed music on reduction of perioperative Anxiety in adult Patients undergoing laparoscopic surgeries under general Anaesthesia

Background &Aims:Preoperativeanxiety in patientsis associated with psychological effects.The current study aimed to compare the effects of self selected(SS) musicand prefixed (PF) musicin reducing preoperative anxiety.Methods:In this study, 90 patients posted for laparoscopic cholecystectomy were randomly divided into three groups equally. Patients in group SS and group PF listened toSSand PFfor 20 minutes in preoperative roomrespectively. Music continued until reversal of anaesthesia. Vitals of patients, VASscore for pain and post operative nausea and vomiting (PONV)score were noted at 1st and 2nd hour after surgery.Results:There was a statistically significant difference in anxiety score between SS and PF (p<0.05), between SS and Control(C)(p<0.05) and between PF and C (p<0.05). After music intervention of 20 minutes , heart rate, SBP at T2 was significantly reduced in SS and PF. At T5, thePONVscore was lower in SS and PF than C. There was significant difference in PONV score between SS and C (p<0.0001) and between PF and C (p<0.0003) There was significant difference inVASscore between SS and PF (p<0.05) , between SS and C (p<0.0001) and between PF and C (p<0.0001)Conclusion:SSmusic was more effectiveandenabled to maintain stable haemodynamic parameters throughout the surgery in reducing anxiety than PFmusic. PONV scores were comparable between SS and PFmusicgroups. SS music was more efficient in providing pain relief than PF music.