Postoperative Nausea And Vomiting Scores Research Articles

Nausea and vomiting after breast cancer surgery, and relationship with tumor receptor status

Breast surgery is associated with frequent post-operative nausea and vomiting (PONV). Studies have suggested that hormonal status affects PONV. Estrogen has been implicated in many emetic syndromes. Estrogen receptor (ER) and progesterone receptor (PR) status in breast tissue are hormonally affected. Kakugawa et al., in 2007, found a clear trend toward higher serum level of estrone, estradiol, and dehydroepiandrosterone sulfate in post menopausal women with PR-positive cancer. To investigate the possibility of an association between ER and/or PR status of breast tumor and incidence of PONV after breast cancer surgery. This observational study included 315 female patients undergoing major breast surgery. Relevant patient data, and intra-operative and postoperative details were noted. Incidence of PONV was noted using the PONV score. Patients were divided into two age groups: less than or equal to 50years and more than 50years of age. The ER and/or PR status of the patient was unknown to the investigator until the final analysis. Use of the chi-squared test revealed no association between ER and/or PR and total PONV. Patients below 50years had higher incidence of total PONV (p=0.023). In patients above 50years, the incidence of PONV was higher in the ER-positive group (p=0.018). The incidence of PONV is higher for patients below 50years of age. The positive association between ER positivity and PONV in patients above 50years of age could be attributed to the altered hormonal milieu in these patients and should be investigated further.

Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery

Objective To compare intravenous dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting (PONV), a main complaint that affects almost 40%–75% of patients undergoing laparoscopic gynecologic surgery. Methods In a prospective study, 93 women were divided into 3 groups receiving 4 mg of dexamethasone, 8 mg of dexamethasone, or 4 mg of ondansetron. PONV score was used for assessment during the first 24 hours after surgery. Results The incidence of PONV during the 24-hour postoperative period was highest in the ondansetron group (61%). In the first 3 hours, the incidence of PONV in the ondansetron group was also higher: 51.6% as compared with 22.6% and 36.6% in the dexamethasone 4 mg and 8 mg groups, respectively. The overall incidence of PONV was highest in the first 3 hours as compared with later time periods, and there was a linear trend in decreasing PONV among the groups ( P = 0.017). In the dexamethasone 4 mg group, the request for a rescue antiemetic was significantly lower: 0% as compared with 6.7% and 16.1% in the dexamethasone 8 mg and ondansetron 4 mg groups, respectively. Conclusion Dexamethasone was found to be an efficacious and cost-effective drug for the prophylaxis of PONV.

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.

Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: Con – ‘life is really simple, but we insist on making it complicated’

Risk scores to predict the occurrence of post-operative nausea and vomiting (PONV) are used increasingly to guide prophylactic antiemetic administration. Recent consensus guidelines advocate the use of such models by stating that the use of prophylactic antiemetics should be based on a valid assessment of the patient's individual risk. However, there is still a striking gap between proven and effective antiemetic measures and the poor implementation of current knowledge gained in the last decades. One possible reason for this is that many anaesthesiologists are confused about when to administer which antiemetic to a specific patient. Instead of using a liberal approach, too much emphasis has been placed on risk stratification and risk-adapted antiemetic prophylaxis. The aim of this review is to summarise criticism regarding the latter theoretical issues that in daily practice do not facilitate the use of antiemetic measures. Special focus should be centred on the use of PONV scores to guide antiemetic therapy. We feel that these issues have not been addressed adequately in the past and we would like to stimulate a discussion about whether tools for PONV prediction facilitate or hinder the implementation of antiemetic strategies. Given these implementation problems, we strongly advocate the liberal use of a multimodal antiemetic protocol for all patients. Antiemetics have an excellent safety profile and side-effects of these drugs are mainly mild and transient. Patients may even benefit from these side-effects. For example, corticosteroids are co-analgesics and positively affect mood and convalescence in the post-operative period, and droperidol protects against post-operative headache. Acquisition costs of antiemetics are low and, together with post-operative pain management, antiemetic prophylaxis is probably the area in anaesthesia in which the highest impact on patient satisfaction can be achieved with the least costly and time-consuming interventions.

Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind Study

Background Postoperative nausea and vomiting (PONV) are potential complications in patients after laparoscopic cholecystectomy (LC). Combination antiemetic therapy often is effective for preventing PONV in patients undergoing LC, and combinations of antiemetics targeting different sites of activity may be more effective than monotherapy. Objective The aim of this study was to compare the administration of a subhypnotic dose of propofol combined with dexamethasone with one of propofol combined with metoclopramide to prevent PONV after LC. Methods Sixty adult patients scheduled for LC were randomly assigned to 1 of 2 treatment groups. The patients in group 1 received 0.5 mg/kg propofol plus 8 mg dexamethasone, and those in group 2 received 0.5 mg/kg propofol plus 0.2 mg/kg metoclopramide. The number of patients experiencing nausea and vomiting at 0 to 4, 4 to 12, and 12 to 24 hours postoperatively and as well as additional use of rescue antiemetics were recorded. Results The total PONV rates up to 24 hours postanesthesia were 23.3% and 50% for group 1 and group 2, respectively. Comparisons of the data revealed that at 0 to 4 hours, the number of patients experiencing vomiting was 6 (20%) in group 1 and14 (46.7%) in group 2 ( P = 0.028). The frequency of vomiting in group 1 was significantly lower than that for group 2 ( P = 0.028), and the rate of rescue antiemetic use in group 2 was higher than that in group 1 (20% vs 46.7%; P = 0.028). In the evaluation of PONV based on the nausea and vomiting scale scores, the mean PONV score was 0.4 (0.2) in group 1 compared with 1.0 (0.2) in group 2 ( P = 0.017). There were no significant differences between the values at 4 to 12 hours and at 12 to 24 hours. The frequency of adverse reactions (respiratory depression: 1.3%, 1.3%; laryngospasm: 1.3%, 0%; cough: 1.3%, 0%; hiccup: 1.3%, 0%;) was not significantly different in the 2 groups. Conclusions Administration of a subhypnotic dose of 0.5 mg/kg propofol plus 8 mg dexamethasone at the end of surgery was more effective than administration of 0.5 mg/kg propofol plus metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing LC.

Post-operative nausea and vomiting after gynecologic laparoscopic surgery: comparison between propofol and sevoflurane

BackgroundWe compared the incidence and degree of post-operative nausea and vomiting (PONV) in patients who received general anesthesia with propofol or sevoflurane using the Rhodes index of nausea, vomiting, and retching (RINVR) to assess the degree of PONV quantitatively and objectively during the post-anesthetic period.MethodsWe performed a prospective study involving 38 patients who underwent gynecologic laparoscopic surgery in our hospital between September 2008 and August 2009. Nineteen patients were anesthetized with propofol during the entire anesthetic period and the other 19 patients received 2.0 mg/kg of propofol intravenously, followed by sevoflurane inhalation. Three patients who were anesthetized with sevoflurane were excluded from the analysis because they were omitted during the survey. We studied the patients who had PONV and RINVR scores 1, 6, and 24 hours post-operatively.ResultsThe propofol group had a statistically lower incidence of PONV and lower RINVR scores in the following subclasses within 1 hour of surgery: symptom occurrence; symptom distress; and symptom experience.ConclusionsPropofol at induction and during maintenance of anesthesia can be used to prevent PONV within 1 hour post-operatively in patients undergoing gynecologic laparoscopic surgery.

Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

BackgroundDexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.MethodsIn this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.ResultsDemographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality.ConclusionsPreoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.Trial registration numberNCT01116713

Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery

Study Objective To evaluate the prophylactic use of dexamethasone with sevoflurane in outpatient anorectal surgery. Design Randomized, controlled study. Setting Operating room and Postanesthesia Care Unit of a general hospital. Patients 60 adult, ASA physical status I and II outpatients undergoing anorectal surgery. Interventions Patients were randomized to receive either dexamethasone 5 mg intravenously (IV; Group D; n = 30) or an equal volume of saline (Group S; n = 30) before anesthesia induction. Anesthesia was induced with propofol 2.5 mg.kg −1, fentanyl two μg.kg −1, and 2% lidocaine one mg.kg −1 followed by placement of a Laryngeal Mask Airway. Measurements Frequency of postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, and patient satisfaction were recorded. Main Results Frequency of PONV and VAS pain scores were significantly lower in Group D than Group S ( P < 0.05). The time required for “home readiness” was significantly shorter in Group D than Group S ( P < 0.05). Conclusions The prophylactic administration of 5 mg dexamethasone IV can reduce the frequency of PONV, lower VAS pain scores, facilitate recovery to home readiness, and improve satisfaction in outpatients undergoing anorectal surgery.

Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study

Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effect on other surgical outcomes such as pain and fatigue have been unclear. The purpose of this clinical study was to evaluate the efficacy of preoperative dexamethasone in ameliorating postoperative symptoms after LC. In this prospective, double-blind, placebo-controlled study, 80 patients scheduled for LC were analyzed after randomization to intravenous dexamethasone (8 mg) or placebo. All patients underwent standardized procedures for general anesthesia and surgery, and were recommended to remain in hospital for 3 postoperative days. Episodes of PONV, and pain and fatigue scores on a visual analogue scale (VAS) were recorded. Analgesic and antiemetic requirements were also recorded. There were no apparent side effects of the study drug. Seven patients (18%) in the dexamethasone group reported nausea, compared with 16 (40%) in the placebo group (p = 0.026). One patient (3%) in the dexamethasone group and 7 (18%) in the placebo group reported vomiting (p = 0.025). Dexamethasone significantly reduced the postoperative VAS pain score (p = 0.030) and VAS fatigue score (p = 0.023). The mean number of patients requiring diclofenac sodium 50 mg was 0.9 +/- 1.3 in the dexamethasone group and 2.2 +/- 2.5 in the placebo group (p = 0.002). The regimen we employed is safe and without apparent side effects. These results suggest that preoperative dexamethasone (8 mg) significantly reduces the incidence of PONV, pain, and fatigue after LC.

Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting

Recent warnings regarding the safety of droperidol have limited use of this drug as an antiemetic. Haloperidol, a butyrophenone derivative similar to droperidol, has not been rigorously evaluated as an antiemetic. The aim of this study was to compare the prophylactic antiemetic efficacy of haloperidol vs ondansetron for the prevention of postoperative nausea and vomiting (PONV) after general anesthesia. Ninety non-smoking female patients were eligible to participate in this randomized double-blinded study. Approximately 30 min before the end of surgery, patients were randomly assigned to receive either haloperidol 2 mg iv, or ondansetron 4 mg iv, respectively. The incidence of PONV, average pain and sedation scores, recovery times, and changes of the rate-corrected QT (QTc) interval were observed postoperatively. The proportion of patients who experienced PONV in the first 24 hr was similar in the two groups (28% and 26% for haloperidol and ondansetron groups, respectively). The incidence of PONV was significantly less in both groups than predicted according to the patients' underlying risks (53% for the haloperidol group, P=0.016; 51% for the ondansetron group, P=0.015). Pain scores, sedation scores, and recovery times were similar in the two groups, and no prolongation of the QTc interval was observed in either group. Haloperidol 2 mg iv given 30 min before the end of surgery is effective in preventing PONV, with efficacy comparable to ondansetron 4 mg iv for the first 24 hr after general anesthesia.

Nitrous Oxide Does Not Aggravate Postoperative Emesis After Orthognathic Surgery in Female and Nonsmoking Patients

The purpose of this study was to evaluate the effect of supplemental nitrous oxide on postoperative nausea and vomiting (PONV) after propofol anesthesia for orthognathic surgery in female and nonsmoking patients. We compared PONV in 28 ASA-I female nonsmoking patients undergoing orthognathic surgery. Anesthesia was induced with propofol combined with fentanyl, and tracheal intubation was facilitated with vecuronium. Anesthesia was maintained with propofol with or without nitrous oxide. No patient received neostigmine. PONV was assessed as score 0 (no PONV), score 1 (nausea), and score 2 (vomiting) during the 24-hour recovery period. There were no differences in the patients' characteristics, operation, anesthesia and emergence time, fluid transfusion, blood loss, urine output, and total propofol and fentanyl doses between the 2 groups. There was also no difference in PONV score in 2 groups. Only 1 patient in each group vomited. It is suggested that supplemental nitrous oxide does not aggravate PONV after propofol anesthesia for orthognathic surgery in female nonsmoking patients.

Transcutaneous electrical nerve stimulation in the prevention of postoperative nausea and vomiting after elective laparoscopic cholecystectomy

Study Objective To examine the effectiveness of transcutaneous electrical nerve stimulation (TENS) on postoperative nausea and vomiting (PONV). Design Randomized, prospective, controlled study. Setting Gazi University Medical School Hospital. Patients 40 ASA physical status I-II patients who underwent elective laparoscopic cholecystectomy. Interventions Patients were randomly divided into two equal groups. Group I received TENS (stimulation group), whereas group II served as the control group (nonstimulation group). In group I, one electrode was applied to the hairless skin on the neck as anode, and the other 2 (electrodes) were applied to the mastoid area. The stimulator at a frequency of 5 Hz, 50 milliseconds, with a current density of 0.5 to 4 mA was applied on the trapezoid area for 6 hours to all patients postoperatively. Measurements All patients in both groups were evaluated for side effects, antiemetic effects, and analgesic and antiemetic need for 24 hours. Main Results Postoperative nausea and vomiting, frequency of dizziness, additional antiemetic and analgesic need, and PONV scores were lower in group I than group II. Conclusions Electrical stimulation of the vestibular system may be useful in the prevention of PONV.

The Effects of Supplemental Oxygen on Postoperative Nausea and Vomiting, Pain, and Stress Hormones

S 53 Background: Supplemental oxygen has been reported to diminish postoperative nausea and vomiting (PONV). Surgical trauma causes increased response of stress hormones. Therefore, we aimed to investigate whether supplemental oxygen attenuates release of adrenocorticotrophic hormone (ACTH) and cortisol as well as PONV in patients undergoing thyroidectomy. Methods: One hundred female patients were randomly assigned to two groups: 30% oxygen (Group 30) and 80% oxygen (Group 80). The incidence and the severity of PONV and pain score were evaluated 2, 6, 24 h postoperatively. PaO2, ACTH and cortisol were measured in 40 patients before tracheal intubation under 100% oxygen and at the end of surgery under designated oxygen concentration. Results: The PaO2 at induction was similar between the groups, but significantly higher in the group 80 than group 30 at the end of surgery. There were no differences in the incidence and the severity of PONV and pain score postoperatively between the groups. ACTH increased significantly at the end of surgery in both groups, but cortisol did not. There were no differences in ACTH and cortisol between the groups. Conclusions: Supplemental oxygen during thyroidectomy did not reduce the incidence and severity of PONV, postoperative pain, and stress hormone responses. (Korean J Anesthesiol 2007; 52: S 53~8) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

The Effect of High FiO2Plus Liberal Intraoperative Fluid on the Early PONV and Pain in Patients undergoing Intra-abdominal Surgery

Background: The previous studies on the influence of perioperative supplemental oxygen or generous fluid on postoperative nausea and vomiting (PONV) were inconsistent. We hypothesized in this trial that together with supplemental intraoperative oxygen and liberal fluid therapy would decrease PONV and pain. Methods: Two hundred ASA 1 or 2 patients undergoing laparotomy and laparoscopic abdominal or gynecological surgery were randomly assigned to one of 4 groups: intraoperative FiO2 0.3 and crystalloid 6 ml/kg/h; FiO2 0.3 and 18 ml/kg/h; FiO2 0.8 and 6 ml/kg/h; FiO2 0.8 and 18 ml/kg/h. The incidence of PONV, nausea and pain scores, and amount of rescue antiemetic and analgesic drugs were studied. Results: Overall incidence of PONV was 38%, 50%, 48%, 44% for group 1, 2, 3, and 4, respectively. There were no statistically significant differences among the 4 groups in the incidence of PONV, degree of nausea and pain, and the amount of antiemetics and analgesics in 2, 6, and 24 h postoperatively. The number of laparotomy and laparoscopy, and gender ratio were similar among the groups. Conclusions: We could not demonstrate an advantage of combination of intraoperative supplementary oxygen and liberal fluid in reducing PONV, pain, and amount of antiemetics and analgesics after intra-abdominal surgery. (Korean J Anesthesiol 2007; 52: S 32～6)

Ondansetron, Orally Disintegrating Tablets Versus Intravenous Injection for Prevention of Intrathecal Morphine-Induced Nausea, Vomiting, and Pruritus in Young Males

In this study we compared the efficacy of orally disintegrating tablets (ODT) and IV ondansetron for preventing spinal morphine-induced pruritus and postoperative nausea and vomiting (PONV) in healthy young male patients. Patients who received bupivacaine with 0.20 mg morphine for spinal anesthesia were randomly assigned to the ODT group (ODT ondansetron 8 mg, n = 50), the IV group (4 mg ondansetron IV, n = 50), or the placebo group (n = 50). Each individual was assessed for pruritus, postoperative nausea and vomiting, and pain at 0, 2, 6, 12, 18, and 24 h after surgery using three distinct visual analog scales. The frequencies of postoperative nausea and vomiting and frequencies of requirement for rescue antiemetic and antipruritic were recorded. There were no significant differences among the three groups with respect to incidence or severity of PONV or postoperative pain visual analog scale scores. The incidences of pruritus in the ODT (56%) and IV (66%) groups were significantly different from that in the placebo group (86%) (P < 0.02 for both). Only the ODT group had significantly lower mean pruritus visual analog scale scores at 0, 2, 6, and 12 h postsurgery than the placebo group (P < 0.023 for all). The frequency of requirement for rescue antipruritic was significantly less in the ODT group than the placebo group (P = 0.013). Both ODT ondansetron 8 mg and IV ondansetron 4 mg are more effective than placebo for preventing spinal morphine-induced pruritus, but neither form of this agent reduces spinal morphine-induced postoperative nausea and vomiting in this patient group.

Risk Factors of Postoperative Nausea and Vomiting: Development of Korean Risk Model

Background: Postoperative nausea and vomiting (PONV) along with postoperative pain is one of the most frequently encountered complaints after the surgery. The goal of this study is to elucidate the probable high risks factors of PONV by making 24 hr-observations on 4008 patients undergone general anesthesia. Methods: PONV scores (0: no PONV; 1, nausea; 2, retching; 3, vomiting) and characteristics of patient, surgery, anesthesia were recorded by patient interview and chart review at post anesthesia care unit and at ward 24 hours after operation. Risk factors of PONV were investigated by Odds ratio and P value. Multiple regression analysis was performed to produce the provability of PONV. Results: Incidence of PONV was 26.1% at PACU and 22.9% at ward. Total incidence of PONV during 24 hrs was 39.3. High risk factors of PONV were as follows in decreasing order: 1) female, 2) history of PONV or motion sickness, 3) nonsmoker, 4) operative time of longer than 60 minutes and 5) patient controlled analgesia. P (probability of PONV) = 1/1 Z = 1.928+0.899 (Gender)+0.664 (Hx)+0.558 (OP-duration)+0.261 (Smoking Status)+0.184 (Postop-opioid). Conclusions: We could identify 5 risk factors and developed a Korean PONV risk model enabling to predict the probability of PONV by this study of 4008 patients.

Management of post-strabismus nausea and vomiting in children using ondansetron: a value-based comparison of outcomes

This study evaluated the clinical efficacy and cost-effectiveness of prophylactic ondansetron versus early ondansetron treatment in the management of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair using clinically meaningful outcomes and value-based principles. One hundred and fifty children were randomly assigned to either prophylactic (P) or early symptomatic treatment only (T) group (n = 75). Children in group P received ondansetron 100 micrograms kg-1 i.v. and those in group T received placebo at the end of the procedure. After surgery, at the earliest sign of nausea or vomiting, children in both groups received ondansetron 100 micrograms kg-1 i.v. Besides the incidence of PONV, non-surrogate (fast tracking time, duration of stay in the postanaesthesia care unit (PACU) and parental satisfaction scores), therapeutic (numbers needed to prevent and treat) and pharmacoeconomic (cost to benefit a child and cost per PONV-free child) outcome measures were evaluated. The incidences of PONV in the immediate, early, late and first 24-h periods were significantly less in group P (20, 12, 19 and 35% respectively) than in group T (37, 29, 47 and 72%, P < 0.05). Time to achieve fast-track eligibility and duration of PACU stay were significantly shorter in group P (P < 0.001). Children in group P had superior mean (SD) parental satisfaction scores (8.2 (1.8)) compared with those in group T (6.8 (1.7), P < 0.001). The number needed to prevent PONV was 2 and the number needed to treat PONV was 9. The cost to benefit a child was more than fourfold less and the cost per PONV-free child was 35% less in group P. Compared with early symptomatic treatment with ondansetron, prophylactic ondansetron shortened fast-tracking time and duration of PACU stay and improved parental satisfaction and therapeutic outcomes at a lower direct cost.

The Effects of Propofol Anesthesia or Prophylactic Droperidol on Postoperative Nausea and Vomiting in Patients Undergoing a Gynecologic Laparoscopy

Background: Postoperative nausea and vomiting (PONV) is a common complication of a gynecologic laparoscopy. This study was designed to assess the effect of prophylactic droperidol 1 mg or propofol as the induction and maintenance anesthetic agent for prophylaxis of PONV in women undergoing a gynecologic laparoscopy. Methods: Eighty ASA physical status 1, 2 patients undergoing an elective gynecologic laparoscopy were randomly allocated into four groups. Group 1 (n = 20) recieved an intravenous placebo of noraml saline 1 ml prior to induction of anesthesia and N2O-enflurane general anesthesia. Group 2 (n = 20) recieved an intravenous placebo of noraml saline 1 ml prior to induction of anesthesia and N2O-propofol general anesthesia. Group 3 (n = 20) recieved intravenous prophylactic droperidol 1 mg prior to induction of anesthesia and N2O-enflurane general anesthesia. Group 4 (n = 20) recieved intravenous prophylactic droperidol 1 mg prior to induction of anesthesia and N2O-propofol general anesthesia. Results: The incidence and severity of PONV and sedation scores were assessed at 0, 30 min, 1, 3, 6, 24 and 48 hours postoperatively. The incidence of PONV was 75% in group 1, 10% in group 2, 30% in group 3 and 20% in group 4. The incidence of PONV during the first 6 hours postoperatively was 70% in group 1, 0% in group 2, 10% in group 3 and 5% in group 4 and there were no statistical differences among the four groups in the 6 to 24 hour postoperative period. Sedation scores were significantly higher in group 3 and 4 than in 1 and 2 in the 3 to 6 hour postoperative period. Conclusions: Propofol anesthesia, prophylactic droperidol 1 mg and a combination to prevent PONV were highly effective during the first 6 hours postoperatively. (Korean J Anesthesiol 2001; 40: 348∼ 358) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

PREEMPTIVE USE OF KETOROLAC IN LIMITED ORTHOPEDIC SURGERY

S300 INTRODUCTION: Preemptive analgesia may prevent "sensitization" of the central nervous system and contribute to better postoperative pain relief with lower total doses of analgesics [1]. Ketorolac has been demonstrated to possess preemptive analgesic effects in hip surgery, but with increased blood loss [2]. The present study was designed to determine if ketorolac has preemptive effects in limited orthopedic surgery under tourniquet where the effects on blood loss should be minimal. METHODS: After IRB approval and informed consent, 29 patients ages 18-64, ASA 1-2, for ankle fracture repair, were enrolled in this double blind, randomized controlled trial. All patients received identical general anesthetics. Each patient was randomly assigned to one of two treatment groups: PRE (n=14) 30mg ketorolac administered IV 5 min. prior to tourniquet inflation with placebo after inflation and POST (n=15) 30mg ketorolac administered IV 5 min. after tourniquet inflation with placebo prior to inflation. All patients received postoperative morphine PCA. Morphine usage, visual analogue pain scores (VAS), postoperative nausea and vomiting scores (PONV) and presence/absence of excessive bleeding were recorded at 2, 4, 6, 8, 10 and 24 hours after tourniquet inflation. Postoperative nausea and vomiting (PONV) was recorded on a 5 point scale from 1 = no nausea to 5 = nausea with emesis. ANOVA was used to analyze morphine usage and VAS, and Kruskall-Wallis One-Way ANOVA for PONV. Statistical significance was defined as P<0.05. RESULTS: Patient demographics were similar. Two patients were eliminated in each group due to protocol errors or, in one case, to a surgical decision to abandon tourniquet usage. Group PRE patients had lower, but not statistically significant morphine requirements than Group POST at 2, 4 and 6 hours after tourniquet inflation. Both groups had similar requirements at 8, 10 and 24 hours (see Table 1).Table 1: Morphine requirements in [micro sign]g/Kg/hr (mean +/- 1 S.D.)VAS were identical between the PRE and POST groups. PONV was less in PRE at 6hr (PRE = 1 +/- 0, POST = 1.9 +/- 1.2, P = 0.006) and 8hr (PRE = 1.6 +/- 1.2, POST= 1.8 +/- 1.2, P = 0.008). No patient had excessive postoperative bleeding. DISCUSSION: Preliminary results of this study suggest a trend towards lower PCA requirements in the PRE group at approximately 2-6 hours after ketorolac administration, thus suggesting the existence of a preemptive analgesic effect. Lower PONV scores in the PRE group may be due to the lower morphine requirements. It is quite possible that the results will become significant once more patients are enrolled.