Postoperative Nausea And/or Vomiting Research Articles

Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial.

Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway. One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications. No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75-0) vs. 2 (5.25-0) in PACU, 5.5 (7-3) vs. 6 (7-4) at 6 h, 2 (6-0) vs. 3 (5.25-1.75) at 12 h, and 2 (3.75-0) vs. 1 (2-0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes. Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.

Intraoperative Prophylaxis with Palonosetron for Postoperative Nausea and/or Vomiting in Adults Undergoing Cardiothoracic Surgery Under General Anesthesia: A Single-Center Retrospective Study

This study assessed the efficacy of palonosetron, alone or with dexamethasone, in reducing postoperative nausea and/or vomiting (PONV) and its impact on hospitalization duration in patients who undergo adult cardiothoracic surgery (CTS) under general anesthesia. This retrospective analysis involved 540 adult patients who underwent CTS from a single-center cohort, spanning surgeries between September 2021 and March 2023. Sensitivity, logistic, and Cox regression analyses evaluated antiemetic effects, PONV risk factors, and outcomes. At the Virginia Mason Medical Center (VMMC), Seattle, WA. Adults undergoing cardiothoracic surgery at VMMC during the specified period. Patients were categorized into the following 4 groups based on antiemetic treatment: dexamethasone, palonosetron, dexamethasone with palonosetron, and no antiemetic. Primary outcomes encompassed PONV incidence within 96 hours postoperatively. Secondary outcomes included intensive care unit stay duration and postoperative opioid use. Palonosetron recipients showed a significantly lower PONV rate of 42% (v controls at 63%). The dexamethasone and palonosetron combined group also demonstrated a lower rate of 40%. Sensitivity analysis revealed a notably lower 0- to 12-hour PONV rate for palonosetron recipients (9% v control at 28%). Logistic regression found decreased PONV risk (palonosetron odds ratio [OR]: 0.24; dexamethasone and palonosetron OR: 0.26). Cox regression identified varying PONV hazard ratios related to female sex, PONV history, and lower body mass index. This single-center retrospective study underscored palonosetron's efficacy, alone or combined with dexamethasone, in managing PONV among adult patients who undergo CTS. These findings contribute to evolving antiemetic strategies in cardiothoracic surgery, potentially impacting patient outcomes and satisfaction positively.

Antiemetic prophylaxis with droperidol in morphine-based intravenous patient-controlled analgesia: a propensity score matched cohort study

BackgroundThere are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to evaluate the antiemetic benefits and sedation effects of droperidol in morphine-based IV-PCA.MethodsPatients who underwent major surgery and used morphine-based IV-PCA at a medical center from January 2020 to November 2022 were retrospectively analyzed. The primary outcome was the rate of any postoperative nausea and/or vomiting (PONV) within 72 h after surgery. Propensity score matching was used to match patients with and without the addition of droperidol to IV-PCA infusate in a 1:1 ratio. Multivariable conditional logistic regression models were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsAfter matching, 1,104 subjects were included for analysis. The addition of droperidol to IV-PCA reduced the risk of PONV (aOR: 0.49, 95% CI: 0.35–0.67, p < 0.0001). The antiemetic effect of droperidol was significant within 36 h after surgery and attenuated thereafter. Droperidol was significantly associated with a lower risk of antiemetic uses (aOR: 0.58, 95% CI: 0.41–0.80, p = 0.0011). The rate of unintentional sedation was comparable between the patients with (9.1%) and without (7.8%; p = 0.4481) the addition of droperidol. Postoperative opioid consumption and numeric rating scale acute pain scores were similar between groups.ConclusionsThe addition of droperidol to IV-PCA reduced the risk of PONV without increasing opiate consumption or influencing the level of sedation. However, additional prophylactic therapies are needed to prevent late-onset PONV.

Intraoperative Sufentanil Consumption and the Risk of Postoperative Nausea and/or Vomiting: A Retrospective Observational Study.

Post-operative nausea and/or vomiting (PONV) is a common post-operative adverse reaction and has been associated with post-operative sufentanil injection. The assessment of the relationship between intraoperative opioid consumption and PONV has been understudied. This study examined the relationship between intraoperative sufentanil administration and PONV. This was a single-center retrospective observational study. Patients who underwent video-assisted thoracoscopic surgery under general anesthesia with the preoperative thoracic paravertebral block between January 2017 and June 2020 at the Peking University People's Hospital were recruited for this study. Patients were grouped into two groups according to whether or not PONV occurred on postoperative day 1 (POD1). The factors associated with PONV were analyzed using logistic regression. A total of 2733 patients, 1510 males and 1223 females, were included in this study. Among them, 143 patients developed PONV, a 5.2% (143/2733) PONV incidence. Logistic regression analysis showed that female, nonsmoking, sufentanil patient-controlled intravenous analgesia (PCIA), POD1 opioids consumption, and a time-weighted average of intraoperative sufentanil (twSuf) were associated with PONV. All patients were further divided into four subgroups based on intraoperative twSuf. Logistic regression analysis revealed that twSuf higher than 0.21μgkg-1h-1 was an independent risk factor for PONV. Intraoperative sufentanil injection with a twSuf higher than 0.21μgkg-1h-1 increased the risk of PONV in patients undergoing thoracoscopic surgery under general anesthesia after a preoperative thoracic paravertebral block.

Effects of intraoperative esketamine addition on gastrointestinal function after benign gynaecological laparoscopic surgery: a double-blind, randomized controlled study

BackgroundGastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery.MethodsThis was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing’an Meng People’s Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were analyzed in both groups.ResultsA total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter first postoperative flatus time (11 [8, 14] h vs. 14 [11, 18], p = 0.003) and anaesthesia resuscitation time (7 [6, 9] h vs. 9 [7, 11] h, p = 0.013)were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007).ConclusionThe esketamine-based opioid-sparing anaesthetic protocol can shorten the postoperative first flatus time after benign laparoscopic surgery in gynaecology, and reduce the incidence of PONV. In addition, the application of esketamine may reduce the postoperative opioid dose requirement of patients.Trial registration: This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021).

Superficial Parasternal Intercostal Plane Blocks (SPIB) With Buprenorphine, Magnesium, and Bupivacaine for Management of Pain in Coronary Artery Bypass Grafting.

Introduction Management of post-operative pain after cardiac surgery continues to be a challenge; inadequate management of pain can lead to increased morbidity, impaired physical function with potential delay in recovery, increased perioperative and chronic opioid consumption, increased cost of care, and a decreased quality of life. This study aimed to evaluate the effect of adding buprenorphine and magnesium to bupivacaine for superficial parasternal intercostal plane blocks (SPIB) on pain and opioid consumption in the first 24 hours after coronary artery bypass grafting (CABG). Methods Patients undergoing CABG were divided into the following four groups: saline SPIB, SPIB with bupivacaine (BPVC), SPIB with bupivacaine and buprenorphine (BPVC+BPRN), and SPIB with bupivacaine, buprenorphine, and magnesium (BPVC+BPRN+MG).The primary outcomes were pain scores and opioid consumption after SPIB; the secondary outcomes were post-operative nausea and vomiting, time to extubation, and length of stay (LOS) in the intensive care unit and hospital. Results One hundred thirty-four eligible patients undergoing CABG were randomized to either the saline (n=27), BPVC (n=20), BPVC+BPRN (n=24), or BPVC+BPRN+MG (n=29) group. All of the intervention groups combined (BPVC, BPVC+BPRN, and BPVC+BPRN+MG) had decreased pain scores and decreased opioid consumption when compared to the saline group; although not statistically significant, visual analog scale (VAS) scores trended downward at most time points with BPVC versus saline, BPVC+BPRN versus BPVC, and BPVC+BPRN+MG versus BPVC+BPRN. There was no difference among the study groups in the incidence of post-operative nausea and/or vomiting (PONV), time to extubation, hospital LOS, and ICU LOS. Conclusion In this prospective, double-blind, placebo-controlled trial, we found that SPIB with local anesthetic is effective at reducing VAS scores and opioid consumption after CABG. Further study is needed to determine whether the addition of adjuvants can further improve pain control and opioid consumption.

A Risk Score for Postoperative Nausea and/or Vomiting in Women Undergoing Cesarean Delivery With Intrathecal Morphine

(Int J Obstet Anesth. 2020;44:126–130) Up to 4 of 5 cesarean delivery (CD) patients receiving intrathecal morphine are affected by postoperative nausea and/or vomiting (PONV). Existing PONV risk assessment scores including the Apfel score were developed based on the general surgical population, while none have been designed specifically for obstetric patients. This post hoc analysis aimed to develop a PONV prediction model (the Duke score) specifically for the obstetric population and compare it to the Apfel score.

Unilateral Acupuncture Reduces Postoperative Pain Scores in Children Undergoing Adenotonsillectomy: A Randomized Controlled Trial.

PurposeAcupuncture ameliorates several pain disorders including postoperative pain. This can help to decrease the need for postoperative analgesics. We aimed to evaluate the effectiveness of acupuncture as an adjuvant scheme reduce both intraoperative and postoperative analgesia needs in children undergoing adenotonsillectomy.MethodsThis was a randomized controlled single-blinded trial that was performed over sixty children scheduled for adenotonsillectomy. They were randomly allocated to either an intervention group that received general anesthesia plus acupuncture or a control group which received general anesthesia alone. The primary outcome was the measurement of postoperative pain scores. Secondary outcomes included measurement of time to the first request of postoperative analgesia, the number of children requesting postoperative analgesics in the first 2 hours, the incidence of postoperative complications including postoperative nausea and/or vomiting (PONV), and emergence agitation (EA).ResultsAThe Wong-Baker FACES pain scores at rest and on swallowing were significantly lower in the intervention group than in the control group postoperatively. The time to the first request of postoperative analgesia was delayed in the intervention group versus the control group, with less number of patients who have requested additional analgesia during the first 2 hours postoperatively. Postoperative agitation was lower in the intervention group versus the control group patients. However, the incidence of PONV was not statistically different between study groups.ConclusionCombined acupuncture with general anesthesia in children undergoing adenotonsillectomy provided better postoperative pain control with no adverse effects.

Impact of Intraoperative Dexamethasone After Scheduled Cesarean Delivery: A Retrospective Study

(Int J Obstet Anesth. 2020;41:39–46) In current anesthesia practice, a common preventative medication for postoperative nausea and/or vomiting (PONV) is dexamethasone. However, its efficacy when administered as a single intraoperative dose for procedures performed under spinal anesthesia is unclear. Analgesic effects of dexamethasone administered in the perioperative period have also been described in the literature. The investigators of this impact study aimed to determine the postoperative benefits from the administration of a single dose of intravenous (IV) dexamethasone during cesarean delivery (CD) performed under spinal or combined spinal epidural (CSE) anesthesia.

Association between intra-operative fentanyl dosing and postoperative nausea/vomiting and pain

Postoperative nausea and/or vomiting (PONV) is one of the anaesthesia-related effects most dreaded by patients and may delay hospital discharge. Although scores and risk factors are established, many were developed before contemporary anaesthesia regimens and without focussing on modifiable anaesthesia-related variables. To examine whether, in association with a contemporary anaesthesia regimen, there is an association between intra-operative fentanyl dose and PONV, and, second, postoperative pain within the first 24 h. Prospective, observational cohort. Single-centre university hospital. Inclusion criteria were opioid-naive patients without chronic pain and with a simplified Apfel score at least 2 undergoing abdominal, gynaecological or otorhinolaryngological inpatient surgery. None. With logistic regression, we examined three models of increasing complexity exploring the relationship between PONV and fentanyl dosing: Model 1, simplified Apfel score + intra-operative fentanyl; Model 2, Model 1 + pre-emptive antiemetic prophylaxis; Model 3, Model 2 + postoperative morphine. Model 1 was the primary analysis. Second, we explored whether or not postoperative pain scores were associated with intra-operative fentanyl dosing. From the 363 patients, 163 (45%) experienced PONV, despite the use of total intravenous anaesthesia with propofol in more than 80% of the cohort, and some 66% of patients receiving additional antiemetic agents. After adjusting for the simplified Apfel score, higher intra-operative fentanyl dose was associated with PONV: odds ratio per μg h, 1.006 [95% confidence interval (CI) 1.002 to 1.010]. Including intra-operative fentanyl in the simplified Apfel score also increased the area under the receiver operator characteristics curve [0.601 (95% CI 0.555 to 0.662) vs. 0.651 (95% CI 0.594 to 0.707); P = 0.016]. Finally, a higher intra-operative fentanyl dose was associated with higher 24 h pain scores (P = 0.001) and a trend towards higher 24 h morphine requirements (P = 0.055). Even when using propofol and antiemetic agents, PONV within the first 24 h remained higher than expected. Intra-operative fentanyl, a modifiable risk factor, is associated with the incidence of PONV and postoperative pain. ClinicalTrials.gov, NCT03201315.

Outcomes With Moderate and Deep Sedation in an Oral and Maxillofacial Surgery Training Program

The purpose of the present study was to determine the complication rate associated with the administration of intravenous (IV) sedation in an oral and maxillofacial surgery (OMS) residency training program. We performed a prospective cohort study that enrolled patients who had received IV sedation for various oral surgery procedures in the clinic setting of an oral and maxillofacial surgery residency training program. The composition of the anesthesia team included residents who had completed their anesthesia rotation, ranging from postgraduate year (PGY)-1 to PGY-4. Each trainee chose their own anesthetic technique and completed a form that included demographic data, types and amounts of anesthetic used, and any intraoperative or postoperative complications encountered. All sedations were performed by a single provider with oversight by an attending oral and maxillofacial surgeon. The demographic and medication data were used as predictor variables. The outcome variables included any reported complications. The Fisher exact test was used to compare the complication rate by subgroup. The study included 1005 patients treated during an 18-month period. The overall complication rate was 2.29%. The most common complication reported was postoperative nausea (n=10; 0.99%), with 1 patient experiencing emesis. Other complications included laryngospasm (n=1), prolonged recovery (n=3), failed sedation because of agitation (n=1), intraoperative hypertension (n=1), postoperative hypertension (n=1), ST elevation (n=1), IV infiltration (n=2), syncope during IV access (n=1), and respiratory depression (n=2). No deaths or no adverse events requiring escalation of the level of care occurred. Ketamine use resulted in a greater rate of postoperative nausea (1.21%), and propofol was associated with a lower rate of postoperative nausea (0.68%). Male patients experienced a greater rate of complications compared with female patients overall (2.4 vs 2.2%). However, the female patients had a greater rate of postoperative nausea and vomiting (0.96 vs 1.19%). Of those who had reported a previous history of postoperative nausea and/or vomiting (PONV), 50% experienced symptoms after sedation. The average length of the procedure was longer in the group that had experienced complications compared with those who had not (37.5 vs 31.6minutes). None of these reported differences were statistically significant. The results of the present study have demonstrated that the modern IV sedation anesthesia technique used in OMS training programs is safe and the complication rate is low. Postoperative nausea was the most common complication. Ketamine can increase the risk of PONV, and propofol can reduce the risk of PONV. However, larger studies are required for conclusive findings. A history of PONV is a good predictor of PONV. The length of the procedure might increase the risk of complications.

Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled trial.

Various adjuvants have been tried to improve quality and increase duration of local anaesthetics during various nerve blocks. We aimed to evaluate the effect of adding midazolam to bupivacaine on rectus sheath (RS) block in patients undergoing umbilical or epigastric hernia repair. In all, 60 adult patients were divided into two equal groups, each group included 30 patients. Group I received 20ml of bupivacaine hydrochloride 0.25% + midazolam 50μg/kg in 2ml saline 0.9% (Midazolam group, n=30), whereas Group II received 20ml of bupivacaine hydrochloride 0.25% + 2ml saline (Control group, n=30) for RS block on each side. The primary outcome was post-operative 48h morphine consumption, whereas secondary outcomes included analgesia duration, post-operative pain, as evaluated by visual analogue scale (VAS) for pain scoring at 1, 2, 6, 12, 24 and 48h post-operatively, reported post-operative nausea and or vomiting (PONV), somnolence or any adverse drug reactions. The current study showed that addition of midazolam to bupivacaine for RS blockade provided good analgesia as evidenced by a statistically significant less morphine consumption in the post-operative 48h [11.2 (5.3-18.3) vs. 25.9 (15.2-31.0) mg, P=0.002], longer duration of analgesia, lower VAS during post-operative 48h, lower incidence of PONV, somnolence and pruritus. Midazolam addition to bupivacaine for RS blockade provided adjuvant analgesia as supported by less morphine consumption, longer duration of analgesia, and lower VAS score.

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy.

PurposeTo propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience.Material and methodsWe conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia.ResultsIn 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia.ConclusionsInterstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.

Analgesic Effect of Nalbuphine When Added to Intravenous Regional Anesthesia: A Randomized Control Trial

Background: Different adjuvant drugs are currently added to lidocaine for intravenous regional anesthesia (IVRA) to decrease tourniquet and postoperative pain. Objective: The aim of the study was to examine the effect of nalbuphine when added to IVRA. Study Design: Prospective, randomized, double-blind, controlled clinical trial. Setting: Assiut University Hospitals. Methods: One hundred-six adult patients scheduled for unilateral hand surgery under IVRA were randomized into 2 equal groups. The lidocaine-nalbuphine (LN) group received nalbuphine plus lidocaine and the lidocaine (L) group received lidocaine. A tourniquet and postoperative pain were assessed using a visual analogue scale (VAS). The following parameters were measured: onset and recovery time for both sensory and motor blocks, intra- and postoperative analgesic consumption, time to first analgesic request, postoperative nausea and/or vomiting (PONV), hemodynamics, and cortisol levels. Results: Early tourniquet and postoperative pain were significantly lower in the LN group. The onset time for both sensory and motor blocks was significantly shorter in the LN group. In addition, the recovery time for both sensory and motor blocks was longer in the LN group. Intra- and postoperative fentanyl consumption was significantly lower in the LN group with no significance in postoperative diclofenac consumption. The patient first analgesic request was significantly delayed in the LN group (P &lt; 0.0001). There were no significant differences between the 2 groups in PONV, hemodynamic parameters abnormalities, medications adverse events or cortisol levels. Limitations: The inclusion of a study group in which the nalbuphine administered systemically could determine whether its beneficial effects were due to its local or systemic action. Conclusions: Nalbuphine decreases early tourniquet and postoperative pain after IVRA and delays the need for analgesic rescue. In addition, nalbuphine accelerates the onset and prolongs the recovery time for both sensory and motor blocks with no significant adverse events. However, it has no effect on postoperative cortisol levels. Key words: Intravenous, regional anesthesia, lidocaine, nalbuphine, pain, postoperative

The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures

Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).

Controlled Breathing With or Without Peppermint Aromatherapy for Postoperative Nausea and/or Vomiting Symptom Relief: A Randomized Controlled Trial

With little scientific evidence to support use of aromatherapy for postoperative nausea and/or vomiting (PONV) symptoms, this study evaluated controlled breathing with peppermint aromatherapy (AR) and controlled breathing alone (CB) for PONV relief. A single blind randomized control trial design was used. On initial PONV complaint, symptomatic subjects received either CB (n = 16) or AR (n = 26) intervention based on randomization at enrollment. A second treatment was repeated at 5 minutes if indicated. Final assessment occurred 10 minutes post initial treatment. Rescue medication was offered for persistent symptoms. Among eligible subjects, PONV incidence was 21.4% (42/196). Gender was the only risk factor contributing to PONV symptoms (P = .0024). Though not statistically significant, CB was more efficacious than AR, 62.5% versus 57.7%, respectively. CB can be initiated without delay as an alternative to prescribed antiemetics. Data also support use of peppermint AR in conjunction with CB for PONV relief.

Palonosetron versus ondansetron for prevention of postoperative nausea and vomiting during middle ear surgery: a double-blind, randomized, comparative trial

Besides postoperative pain, postoperative nausea and/or vomiting (PONV) is the most frequent and most unpleasant adverse outcome of surgery and general anesthesia. It occurs in 20–30% of patients [1]. Moreover, from the patient’s point of view, the anesthetist is clearly responsible for this ‘big little problem’ during the early postoperative period [2].Although many scientifi c clinical studies have been conducted in recent years to overcome this problem, a global panacea for its total prevention has not been found.One of the approaches to manage PONV is the clinical use of serotonin (5- HT3) receptor antagonists, which represent a new antiemetic drug class with improved effi cacy, prolonged action, and reduced side eff ects. 5-HT3 receptors are located on the nerve terminals of the vagus in the periphery and centrally in the chemoreceptor trigger zone of the area postrema of the medulla oblongata [3].Ondansetron was the fi rst serotonin antagonist, and its introduction was a milestone in the prevention of nausea and vomiting. It was considerably more eff ective and had fewer side eff ects (no extrapyramidal symptoms or sedation) compared with other types of antiemetics [4].Palonosetron is a selective serotonin subtype-3 (5-HT3) receptor antagonist with a strong binding affi nity. It is used to prevent nausea and vomiting caused by cancer chemotherapy. In addition, it was granted FDA approval in March 2008 for the prevention of PONV during the period up to 24 h after surgery [5,6].Th e aim of this study was to assess the effi cacy and safety of palonosetron versus ondansetron for PONV during middle ear surgery (MES).

Bupivacaine intermittent wound irrigation is an effective and cost­ reducing modality for postoperative analgesia after open cholecystectomy

Objectives:To evaluate postoperative outcome of open cholecystectomy in patients receiving local anesthetic (LA) wound irrigation (WI) for postoperative (PO) analgesia. Patients & methods: The study included 40fomale patients with mean age of34.1±3.4 years. All surgeries were peiformed through Kocher's subcostal incision, during muscle cutting, the neurovascular bundle was identified and after peritoneal drainage and closure, an 8F neonatal feeding catheter with fashioned multiple pores was inserted partly between anterior abdominal wall muscles and partly under subcutaneous tissue directly on the neurovascular bundle. Patients were divided into: Control group (Group C) who received WI using 0.9% saline and study group (GroupS) who received 8-hourly WI using 20 ml ofbupivacaine 0.25%for 48 hours. Wound pain was assessed using 10-mm visual analogue scale (VAS). Duration of PO analgesia and frequency of requests and total dose of intravenous mepridine, time for first ambulation and oral intake were recorded. All patients were discharged after irrigation catheter removal on the morning of the 3rd PO day. Results: All surgeries were completed uneventfully without complications within a mean operative time of 46.5±5.3 minutes. Patients who received LA irrigation showed significantly longer duration of analgesia with significantly lower frequency of requests and total dose of mepridine and lower cumulative VAS pain score compared to control group. Mean time tilllst ambulation and oral intake was significantly shorter in Group S compared to group C. Seven patients had postoperative nausea and/or vomiting (PONV), 4 in control and 3 in study group and only one patient in control group required stoppage of oral intake, but all patients responded well to antiemetic therapy. Conclusion: Wound irrigation with bupivacaine significantly improved outcome of open cholecystectomy and could be advocated for various open surgical procedures. The applied modality was safe, effective and cost reducing with significant opioid sparing effect.

Nausea and Vomiting Treatment after Surgery

Nausea and Vomiting Treatment after Surgery

Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center: first large-scale study in Japan

PurposeThe first purpose of this study was to determine the incidence of postoperative nausea and/or vomiting (PONV) 0–48 h after anesthesia at a Japanese cancer center. The second purpose of this study was to collect information on PONV risk factors, independently, in the categories of patient-related, anesthesia-related, and surgery-related factors.MethodsThe frequency of nausea and vomiting was prospectively investigated from 0 to 48 h after anesthesia in 1645 patients (11–94 years of age) at a single medical institution. The occurrence of nausea and vomiting and the use of antiemetics were recorded up to 48 h after anesthesia. Patient-related, anesthesia-related, and surgery-related factors were also recorded and submitted to multiple logistic regression analysis to determine the relationship of these factors to nausea and vomiting.ResultsThe incidences of nausea and vomiting from 0 to 24 h after anesthesia were 40 and 22 %, respectively. The incidences 24–48 h after anesthesia were 10 and 3 %, respectively. Female sex, previous history of PONV, prolonged anesthesia, and remifentanil use during surgery were identified as risk factors for both nausea and vomiting. The use of a volatile anesthetic, use of fentanyl during surgery, postoperative use of opioids, nonsmoking status, and drinking alcohol on 4 or fewer days per week were identified as risk factors for nausea alone.ConclusionThe incidence of and risk factors for PONV at a Japanese cancer center according to this study are comparable to those reported elsewhere.