Prevention Of Postoperative Nausea And Vomiting Research Articles

Postoperative Nausea and Vomiting After Craniotomy: An Evidence-based Review of General Considerations, Risk Factors, and Management.

One of the most common and distressing symptoms after craniotomy is postoperative nausea and vomiting (PONV). PONV could generate delayed postanesthesia care and hospitalization discharge, lower patient satisfaction, and an increase in overall hospitalization costs. The incidence of reported PONV after craniotomy is 22% to 70% without prophylaxis, and a multimodal regimen of medication has been recommended. We conducted a comprehensive literature review of the clinical evidence related to PONV prevention and management after craniotomy. All clinical trials in adult populations relevant to PONV after craniotomy available in English language and indexed in PubMed, Google Scholar and Cochrane Library databases from January 1997 up to September 2018 were retrieved using a combination of free-text words related to PONV in craniotomy. After screening manuscripts identified in the initial search, 23 clinical trials investigating systemic pharmacological intervention versus placebo or active control in patients undergoing craniotomy under general anesthesia met the criteria for inclusion in this comprehensive narrative review. The pathophysiology and mechanisms of PONV after craniotomy could be multifactorial in etiology. Therefore, based on current evidence, PONV management after craniotomy should focus on perioperative patient assessment, surgical, and anesthesia-related risk factors and the selection of systemic pharmacological considerations to reduce its incidence and complications. A multimodal regimen of medication targeting different chemoreceptors in the vomiting center is recommended. Ondansetron and dexamethasone, or their combination, are the most frequently used and effective agents. Further randomized clinical trials comparing different regimens that significantly reduce the incidence of PONV in craniotomy would provide relevant evidence-based data for PONV management in this patient population.

Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: A meta-analysis of randomized controlled trials.

We performed this meta-analysis to evaluate the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) for preventing postoperative nausea and vomiting (PONV) after general anesthesia. We searched PubMed, EMbase, Ovid, Web of Science for relevant randomized controlled trials (RCTs) about TEAS for the prevention of PONV, published through July 31, 2019. The primary outcome was the incidence of PONV, postoperative nausea (PON) and postoperative vomiting (POV) recorded within 24 h after surgery. Secondary outcomes included the numbers of patients needing antiemetic rescue and the incidence of postoperative adverse effects referred to general anesthesia. Data were pooled and analyzed by RevMan 5.3 software. Fourteen RCTs (1653 participants) were included in this meta-analysis. The current results suggested that application of TEAS showed obvious superiority in lower incidence of PONV (relative risk [RR] 0.54, 95% confidence interval [CI] 0.42 to 0.68, P < 0.0001), PON (RR, 0.59, 95% CI 0.49 to 0.71, P < 0.0001), POV (RR 0.46; 95% CI, 0.33 to 0.65, P < 0.0001), lower numbers of patients needing antiemetic rescue (RR 0.56, 95% CI 0.40 to 0.78, P = 0.0005), lower incidence of dizziness (RR 0.43, 95% CI 0.31 to 0.60, P < 0.0001) and pruritus (RR 0.43, 95% CI 0.31 to 0.58, P = 0.02), compared with controlled intervention. TEAS is a reasonable modality to incorporate into a multimodal management approach for the prevention of PONV, PON, POV and associated with lower numbers needing antiemetic rescue, lower incidence of adverse effects after general anesthesia.

Perioperative Administration of Emend® (Aprepitant) at a Tertiary Care Children's Hospital: A 12-Month Survey.

IntroductionAprepitant (Emend®) is a novel antiemetic agent that works through antagonism of neurokinin-1 (NK-1) receptors. To date, there are limited data regarding its use to prevent postoperative nausea and vomiting (PONV) in children. We retrospectively reviewed our initial 12-months experience with aprepitant after it was made available for perioperative use.MethodsThe anesthetic records of patients who received aprepitant were retrospectively reviewed and demographic, surgical, and medication data retrieved.ResultsThe study cohort included 31 patients (15 male and 16 female) ranging in age from 4 to 27 years (15.7 ± 7.4 years) and in weight from 14.4 to 175.7 kilograms (59.3 ± 30.2 kgs). Most of the patients (30 of 31) received the capsule form and 1 received the liquid. The average dose of aprepitant administered was 0.9 ± 0.6 mg/kg; however, only one patient received dosing expressed as mg/kg, and the majority received a 40 mg capsule. All of the patients in the cohort had either a previous history of PONV or risk factors for PONV. PONV occurred in the PACU in 1 patient and during the first 24 postoperative hours in 3 additional patients. No adverse effects related to aprepitant use were noted.ConclusionAprepitant was easily added to the preoperative regimen for pediatric patients who may require it. Our approach limited overuse and subsequent cost concerns. Future studies with a comparator group and a greater sample size are needed to demonstrate its efficacy, especially in comparison to time-honored agents such as ondansetron. No adverse effects were noted in our limited study cohort.

Dose Ginger Have Preventative Effects on PONV-Related Eye Surgery? A Clinical Trial.

BackgroundPostoperative nausea and vomiting (PONV) is considered a common complication of anesthesia, which, particularly in eye surgery, may exert pressure on stitches and open or leak the surgical wound, leading to bleeding.ObjectivesWe aimed to study the effect of ginger on PONV and changes in vital signs after eye surgery.MethodsIn this triple-blind randomized controlled trial, 120 candidate patients for eye surgery were divided into group A (n = 40) and group B (n = 40). Patients in group A received the capsules of ginger 1 g while patients in group B received a placebo one hour before the procedure with 30 mL water. The incidence of nausea and the frequency of vomiting were evaluated at 0, 15, 30 minutes, and 2 hours after the operation. Also, the vital signs of the participants were recorded at certain times.ResultsThe results demonstrated a statistically significant difference in the frequency of nausea between group A and group B (P < 0.05). The severity of nausea was lower in group A than in group B immediately and 2 hours after recovery (P < 0.05). The incidence of vomiting was significantly lower in group A than in group B (P < 0.05). The vital signs were not significantly different between group A and group B (P > 0.05).ConclusionsGinger was effective in the prevention of PONV after eye surgery but had no impact on vital signs. Hence, ginger is proposed to use as a low-cost, prophylactic measure for PONV reduction.

Palonosetron versus ondansetron for prevention of nausea and vomiting after total abdominal hysterectomy under spinal anesthesia with intrathecal morphine: a double-blind, randomized controlled trial

BackgroundHysterectomy is a widely performed surgery and neuraxial anesthesia with intrathecal morphine provides superior quality of recovery. Postoperative nausea and vomiting (PONV) is a frequent problem with intrathecal morphine use. Although palonosetron is effective for prevention of PONV after general anesthesia, its efficacy after neuraxial anesthesia has not been established. This study was conducted to compare the use of palonosetron with ondansetron for PONV prophylaxis in patients at a high risk of PONV during total abdominal hysterectomy (TAH) under spinal anesthesia with intrathecal morphine.MethodsThis prospective, randomized double-blind study conducted at São Rafael Hospital involved 140 American Society of Anesthesiologists physical status I or II women who underwent TAH under spinal anesthesia with intrathecal morphine and who had at least 3 risk factors for PONV based on Apfel’s simplified score. The patients were randomized into two groups: one received palonosetron whereas the other received ondansetron. All patients received spinal anesthesia with intrathecal morphine, as well as dexamethasone plus palonosetron or ondansetron for PONV prophylaxis. The overall incidence of PONV, incidence of early- and late-onset nausea and vomiting, severity of nausea, and use of rescue antiemetics were recorded.ResultsThe overall incidence of PONV was 42.9% in the palonosetron group and 52.9% in the ondansetron group (p > 0.05). No significant differences existed in the incidence of early- and late-onset nausea or early-onset vomiting between the two groups. The incidence of late-onset vomiting was significantly lower in the palonosetron group.ConclusionsPalonosetron exhibited efficacy similar to that of ondansetron for reducing the overall incidence of PONV after TAH under spinal anesthesia with intrathecal morphine; however, palonosetron reduced the incidence of late-onset vomiting significantly better than ondansetron.Trial registrationRBR-4gnm8n (ensaiosclinicos.gov.br), date of registration: August 18, 2014.

Ramosetron versus Palonosetron in preventing postoperative nausea and vomiting in laparoscopic surgeries

Introduction: The incidence of postoperative nausea and vomiting (PONV) following laparoscopic surgeries is very high without antiemetic prophylaxis. 5HT3 receptor antagonists are the most commonly used drug for prevention of PONV. Aims: To compare the effectiveness of intravenous (IV) palonosetron versus ramosetron in prevention of PONV during the 24 hour period in patients undergoing laparoscopic surgeries. Materials and Methods: Sixty patients enrolled for the study were randomly allotted into two groups of thirty each. Group I received 0.075 mg of IV palonosetron and Group II received 0.3 mg of IV ramosetron two minutes before induction of anaesthesia. Both the Groups were similar with respect to age, sex, duration and types of surgery and anaesthetic management. Patients were assessed for the incidence of nausea, retching, vomiting, need for rescue antiemetic and adverse effects at 0-2 hour and 2-24 hours interval following surgery. Students ‘t’ test and chi-square test were used for comparing the parameters. A p-value Results: There was no significant difference between the groups with respect to incidence of nausea, retching and vomiting. The incidence of nausea in group I at 0-2 hours was 3.3% and 6.7% in Group II without a statistically significant difference (p=0.5) and at 2-24 hour interval Group I had 3.3% while Group II had 10% incidence of vomiting with p=0.3 and statistically non-significant. There was no significant difference with respect to incidence of retching, vomiting, need for rescue antiemetic and adverse effects between the two groups. Conclusion: Both palonosetron and ramosetron are equally effective in prevention of PONV in laparoscopic surgeries. Keywords: Laparoscopic surgery, Nausea, Palonosetron, Ramosetron, Retching, Vomiting.

Digital Quality Improvement Approach Reduces the Need for Rescue Antiemetics in High-Risk Patients: A Comparative Effectiveness Study Using Interrupted Time Series and Propensity Score Matching Analysis.

Affecting nearly 30% of all surgical patients, postoperative nausea and vomiting (PONV) can lead to patient dissatisfaction, prolonged recovery times, and unanticipated hospital admissions. There are well-established, evidence-based guidelines for the prevention of PONV; yet physicians inconsistently adhere to them. We hypothesized that an electronic medical record-based clinical decision support (CDS) approach that incorporates a new PONV pathway, education initiative, and personalized feedback reporting system can decrease the incidence of PONV. Two years of data, from February 17, 2015 to February 16, 2016, was acquired from our customized University of California Los Angeles Anesthesiology perioperative data warehouse. We queried the entire subpopulation of surgical cases that received general anesthesia with volatile anesthetics, were ≥12 years of age, and spent time recovering in any of the postanesthesia care units (PACUs). We then defined PONV as the administration of an antiemetic medication during the aforementioned PACU recovery. Our CDS system incorporated additional PONV-specific questions to the preoperative evaluation form, creation of a real-time intraoperative pathway compliance indicator, initiation of preoperative PONV risk alerts, and individualized emailed reports sent weekly to clinical providers. The association between the intervention and PONV was assessed by comparing the slopes from the incidence of PONV pre/postintervention as well as comparing observed incidences in the postintervention period to what we expected if the preintervention slope would have continued using interrupted time series analysis regression models after matching the groups on PONV-specific risk factors. After executing the PONV risk-balancing algorithm, the final cohort contained 36,796 cases, down from the 40,831 that met inclusion criteria. The incidence of PONV before the intervention was estimated to be 19.1% (95% confidence interval [CI], 17.9%-20.2%) the week before the intervention. Directly after implementation of the CDS, the total incidence decreased to 16.9% (95% CI, 15.2%-18.5%; P = .007). Within the high-risk population, the decrease in the incidence of PONV went from 29.3% (95% CI, 27.6%-31.1%) to 23.5% (95% CI, 20.5%-26.5%; P < .001). There was no significant difference in the PONV incidence slopes over the entire pre/postintervention periods in the high- or low-risk groups, despite an abrupt decline in the PONV incidence for high-risk patients within the first month of the CDS implementation. We demonstrate an approach to reduce PONV using individualized emails and anesthesia-specific CDS tools integrated directly into a commercial electronic medical record. We found an associated decrease in the PACU administration of rescue antiemetics for our high-risk patient population.

Antiemetics for Postoperative Nausea and Vomiting in Patients Undergoing Elective Arthroplasty: Scheduled or As Needed?

Postoperative nausea and vomiting (PONV) is one of the most commonly reported adverse experiences after surgery. PONV is a major risk factor for delayed patient mobilization and consequently increased length of hospital stay. The primary objective was to compare the effectiveness of scheduled versus as-needed administration of antiemetic for the prevention and treatment of PONV in the first 48 h after elective hip or knee arthroplasty. The secondary objective was to determine whether PONV affected mobilization on either postoperative day 0 or postoperative day 1 in each study group. This retrospective cohort study used chart reviews for collection of patient data. PONV and mobilization were compared for patients who received antiemetics on a scheduled or as-needed basis following elective hip or knee arthroplasty performed between January and September 2016. Of the 132 patients included in the study, 65 received antiemetics on an as-needed basis and 67 had scheduled antiemetic therapy. Thirty-one (46%) of the patients in the "scheduled" group received antiemetics as intended; the others missed one or more of the scheduled doses. There was no statistical difference in PONV between treatment groups with either intention-to-treat or as-treated analysis. Furthermore, there was no statistically significant difference in mobilization, on either POD 0 or POD 1, between patients who received scheduled antiemetic and those who received antiemetic on an as-needed basis. Scheduled use of antiemetics did not significantly affect PONV, nor did it positively influence mobilization in the postoperative period for patients undergoing elective arthroplasty. Further high-quality prospective studies are needed to confirm these results.

Comparison of ondansetron HCl, granisetron HCl and palanosetron HCl for prevention of postoperative nausea and vomiting following gynaecological surgery under general anaesthesia

Context: Postoperative Nausea and Vomiting (PONV) is associated with many adverse events, which prolong and increase the healthcare cost. Aims: To compare the efficacy of Palanosetron with respect to Granisetron and Ondansetron in prevention of PONV. To study the need of rescue antiemetic and incidence of side effects. Settings and Design: This Prospective, Randomized study was carried out with 150 adult female patients of ASA Grade I & II posted for elective gynecological surgery under GA. Materials and Methods: Patients were divided into three groups of 50 patients each. Group O received injection ondansetron 8 mg IV, Group G received Granisetron 2.5 mg IV & Group P received Palanosetron 0.075 mg iv before GA induction. Episodes of nausea, vomiting, need for rescue antiemetic and side effects were observed for 72 hours in postoperative period. Statistical Analysis Used: Graphpad Software with consideration of significant P value Results: Incidence of nausea and vomiting was more with Ondansetron and minimal with Palanosetron with statistical significance of P Lowest incidence of nausea was found with Palanosetron during 3-24 hours postoperatively (P Complete Control of PONV (No PONV, No rescue drug required) was maximum in P group in all hours of study [P Conclusion: Palanosetron is safe, well tolerated and effective than Granisetron and Ondansetron in reducing the incidence of PONV with less need of rescue antiemetics. Key Messages: Palanosetron is proved better antiemetic than granisetron and ondansetron in prevention of PONV. Keywords: General Anaesthesia, Granisetron, Gynaecological surgery, Ondansetron, Palanosetron, Postoperative nausea and vomiting.

Comparative Study of Ondansetron, Haloperidol or Midazolam in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Gynecological Operations

AbstractBackground: Post-Operative Nausea and Vomiting (PONV) is a common, undesirable effect after surgery per-formed under general anesthesia.Aim of Study: The aim of this study is to compare the effect of ondansetron, haloperidol or midazolam in the pre-vention of PONV in non-smoker females undergoing laparo-scopic gynecological operations under general anesthesia.Patient and Methods: This prospective randomized con-trolled study carried out in Tanta University Hospital for six months (from November 2016 to April 2017). This study included 90 nonsmoker female patients, aged between 18 and 60 years, ASA I & II, scheduled for laparoscopic gynecological operations under general anesthesia. The anesthetic technique, drugs, monitoring, and care were standardized in all the patients during the perioperative period. Patients were ran-domly allocated to one of three groups (n=30 for each group): Group I ondansetron (O) 4mg I.V ondansetron was given at the end of surgery. Group II haloperidol (H) 1mg I.V haloperi-dol was given at the end of surgery. Group III midazolam (M) 2mg I.V midazolam was given 30 minutes before the end of surgery. Dexamethasone 4mg was added to each study group after induction of anesthesia. For the first 24 hours after anesthesia, the presence or absences of nausea, vomiting or retching were recorded. Rescue antiemetic was given if the patient complains of PONV.Results: Mean response during 0-24 hours was 86.7%, 80%, 83.3% in ondansetron, haloperidol and midazolam groups, respectively. No significant difference through the three groups was found. (p-value=0.787). Regarding rescue antiemetics, there was no statistically significant difference between the three groups. Upon arrival to PACU and after 60 minutes, there was no statistically significant difference in sedation score.Conclusion: In the studied surgical population, the efficacy and toxicity of post-operative nausea and vomiting prophylaxis with haloperidol 1mg or midazolam 2mg were not significantly different from ondansetron 4mg.

Effects of prophylactic dexamethasone on postoperative nausea and vomiting in scoliosis correction surgery: a double-blind, randomized, placebo-controlled clinical trial

Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58–0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.

Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting.

The incidence of anaesthetic complications in children is much more than in adults and sometimes with a severe outcome. Patients under one year of age, those with co-morbidities and posted for emergency surgery are at increased risk for morbidities. Sources of information on the risk involved come from institutional audit, closed claim analysis, and large-scale studies of cardiac arrest. A strategy for preventing postoperative nausea and vomiting (PONV), emergence delirium (ED) and postoperative pain should be a part of every anaesthetic plan. A planned multimodal approach should be opted consisting of nonpharmacologic and pharmacologic prophylaxis along with interventions to reduce the baseline risks. The literature in this subject is reviewed extensively to give comprehensive information to postgraduate students about the current understanding of postoperative anaesthetic concerns. Relevant articles from Pub med, review articles, meta-analysis, and editorials were the primary source of information for this article.

Dexasone and metoclopramide vs. granisetron in the prevention of postoperative nausea and vomiting

Introduction. Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. The incidence in adult population is 20?30%, and it can be up to 80% in high-risk population such as gynecological and laparoscopic surgeries. The objective of this study is to compare the efficiency of the combination therapy in comparison with monotherapy in the prevention of PONV in gynecological and laparoscopic surgeries. Methods. An observational prospective cohort study was conducted on a sample of 64 patients (32 patients per group) treated postoperatively at the Gynecology and Obstetrics Ward of GH Subotica, in the period from January?March 2017. The anesthesiologist in charge administered the combination of dexasone and metoclopramide or granisetron in monotherapy according to protocol to patients for prevention of PONV. Results. The demographic characteristics of patients are homogenous and show a statistically significant difference only in the characteristics of length of smoker status and maximum intra-abdominal pressure during surgery. The total incidence of postoperative nausea in the fifth, 15th and 60th minute was 15.6%, 17.2% and 18.7% respectively, and in the fourth, eighth, 12th, and 24th postoperative hour it was 12.5%, 7.8%, 10.9%, and 6.2%, respectively. The incidence of postoperative vomiting in the fifth, 15th, and 60th minute was 1.6%, 4.7%, and 4.7%, respectively, and in the fourth, eighth, 12th, and 24th postoperative hour it was 1.6%, 3.2%, 1.6%, and 1.6%, respectively. Conclusion. The study proved that the combination effect of dexasone and metoclopramide is not inferior compared to monotherapy with granisetron.

Standardised electronic algorithms for monitoring prophylaxis of postoperative nausea and vomiting.

IntroductionDespite comprehensive guidelines with high-grade evidence, postoperative nausea and vomiting (PONV) remains a frequent problem in anaesthesia care. Anaesthesia information management systems (AIMS) may aid clinicians in PONV prevention, but their benefit is critically dependent on the details of implementation into practice. This study aimed to examine strengths and weaknesses of the local AIMS-based algorithm in prevention of PONV.Material and methodsThis retrospective study was conducted in the post-anaesthesia care unit (PACU) of a university hospital and included 10 604 patients aged 18 or older who were followed up in the PACU (intracranial, obstetrical or cardiothoracic surgery excluded) from March 2013 until March 2014. The PONV incidence in PACU and AIMS data validity were analysed.ResultsAdherence to PONV guideline recommendations was considerably low, with only 5749 (54%) of the patients receiving correct PONV prophylaxis. Two thousand seven hundred sixty-six (26%) of the patients received an insufficient PONV prophylaxis, which was associated with an excess PONV incidence (11% vs. 4% with correct prophylaxis, p < 0.001) in the PACU. Two thousand four hundred forty-nine (23%) of all patients were discharged from the PACU with an insufficient PONV prophylaxis despite perioperative digital PONV prevention algorithms.ConclusionsAdherence to PONV prophylaxis guidelines in the era of AIMS software and decision support is still remarkably low. The AIMS data usefulness depends on the user, the type of data input and the configuration of the software. Adherence to correct PONV prophylaxis should be re-evaluated systematically before discharge from PACU.

Effects of dexamethasone and droperidol on postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery

Objective: Laparoscopic gynecological surgery is associated with a high incidence of PONV. In this study, we comparatively investigated the efficacy of combination therapy with dexamethasone plus droperidol versus no therapy in the prevention of PONV following laparoscopic gynecological surgery.

Comparison of Palonosetron and Dexamethasone with Ondansetron and Dexamethasone to Prevent Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy.

Background:Laparoscopic cholecystectomy (LC) is associated with high risk of postoperative nausea and vomiting (PONV) if no prophylactic antiemetic is used.Aims:The study compared prophylactic palonosetron and dexamethasone with ondansetron and dexamethasone in patients undergoing LC.Setting and Design:This prospective, double-blinded, randomized, controlled study was conducted at a tertiary care center.Materials and Methods:The study was carried out in 86 patients who underwent LC. The patients were randomly assigned to following study groups: Group 1 who received palonosetron (0.75 mg) with dexamethasone (8 mg) and Group II who received ondansetron (4 mg) with dexamethasone (8 mg). Patients were observed for nausea with visual analog scale and vomiting episode during 48 h postoperative follow-up.Statistical Analysis Used:Data were analyzed as mean, standard deviation, percentage, and number. The following statistical tests were used: paired or unpaired t-test, Mann–Whitney test, Chi-square test, and repeated ANOVA test.Results:There was no statistically significant difference in heart rate, mean arterial pressure, and oxygen saturation from baseline. During 48 h follow-up, the incidence of nausea, vomiting, and PONV was higher in Group II, but the difference was not statistically significant. The total dose of rescue antiemetic was 2.14 ± 4.15 mg in Group I and 5.00 ± 8.62 mg in Group II patients (P = 0.058). Headache was present in three patients in Group I and two patients of Group II.Conclusion:The palonosetron with dexamethasone is comparable to ondansetron with dexamethasone in the prevention of PONV in patients undergoing LC.

Cost-effectiveness and efficacy of combined dexamethasone–metoclopramide versus ondansetron in the prevention of postoperative nausea and vomiting in women undergoing myomectomy under spinal anesthesia

Background: Postoperative nausea and vomiting (PONV) is a common complication following surgery under spinal anesthesia. The aim of this study was to compare the efficacy and cost-effectiveness of metoclopramide–dexamethasone combination with ondansetron as prophylaxis against PONV in the routine gynecological surgeries amenable to subarachnoid block (SAB). Materials and Methods: Following institutional ethical approval, patients were randomly assigned to receive either ondansetron 4 mg or metoclopramide 10 mg plus dexamethasone 8 mg. All patients had a SAB with 3 ml of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. The primary outcome was proportion of patients in both groups with PONV within 24 h from institution of the SAB. Secondary outcome included comparison of severity of PONV between the two study groups, incidence of side effects related to the study drugs (i.e., sedation, headaches, and movement disorder), and cost implication of the study drugs in both groups. Results: One hundred patients were recruited in this study. The overall incidence of PONV for the 24-h period was 10% (n = 5) and 12% (n = 6) for the ondansetron group and the combination group, respectively. Side effects of the study drugs were minimal and comparable in both groups. The cost-effectiveness ratio, evaluated based on the number of women completely free of nausea and vomiting in each group, was higher at ₦ 177.78 for group ondansetron compared to ₦ 113.63 for metoclopramide and dexamethasone combination group. Conclusion: Combined dexamethasone–metoclopramide had comparable clinical effectiveness with lower cost-effectiveness compared to ondansetron for the prevention of PONV in women undergoing myomectomy under SAB.

Postoperative Nausea and Vomiting Prophylaxis: A Comparative Study of Ramosetron and Palonosetron in Patients Undergoing Laparoscopic Cholecystectomy - A Prospective Randomized Trial.

Background:In spite of the availability of several antiemetic drugs, postoperative nausea and vomiting (PONV) is very common following laparoscopic surgery. Selective 5-hydroxytryptamine type 3 receptor antagonists are considered first-line agents for prophylaxis for PONV.Aims:In this study, we investigated and compared the efficacy of ramosetron and palonosetron in preventing PONV following laparoscopic cholecystectomy.Statistical Analysis:The data were analyzed with Student's t-test and Chi-square test.Settings and Design:This was a randomized, prospective, double-blinded, observational clinical study.Methods:A total number of 80 patients, undergoing elective laparoscopic cholecystectomy surgeries under general anesthesia, were randomly assigned to one of the two equal groups to receive either of the following: Group R – received injection ramosetron 0.3 mg and Group P – received injection palonosetron 0.075 mg intravenous bolus immediately before the induction of anesthesia. The incidence of PONV, adverse effects of the study drugs, and need for rescue antiemetics were recorded over the next 48 h. Primary outcome was the incidence of PONV. Secondary outcomes were adverse effects of the study drugs and need for rescue.Statistical Analysis:The data were analyzed with Student's t-test and Chi-square test.Results:The incidence of a complete response (no PONV and no rescue medication) during 0–3 h in the postoperative period was 82.5% with ramosetron and 90% with palonosetron; the incidence during 3–24 h postoperatively was 80% with ramosetron and 87.5% with palonosetron. During 24–48 h, the incidence was 65% and 90%, respectively (P < 0.05). The incidences of adverse effects were statistically insignificant between the groups.Conclusion:Prophylactic therapy with palonosetron is more effective than ramosetron for long-term prevention of PONV following laparoscopic cholecystectomy.

A Comparative Study Between Palonosetron and Granisetron to Prevent Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

Post operative nausea and vomiting is a frequent complication following general anaesthesia and surgery. There is frequently the case of great distress to patient and it is often the worst memory, uncomfortable of their hospital stay. Prolonged post operative nausea and vomiting may cause unexpected physical, metabolic, psychological and economic effects on the patients which slow down their recovery and reduce their confidence in future surgery and anaesthesia. In the present study, we have the incidence of post operative nausea and vomiting in sixty (60) patients undergoing for elective procedure under general anaesthesia. The patients were randomly divided into two groups (group- P, group- G) of thirty (30) patients each.The Patients of group ‘P’ were received intravenous Inj. Palonosetron 75μg and group ‘G’ received intravenous Inj. granisetron 2.5mg (2.5ml) bolus over 30 second just before peritoneal closure. Both group received a standard general anaesthesia. Postoperative analgesia was provided with per rectal diclofenac suppository (50mg) and Inj. Ketorolac Tromethamine 30mg 8 hourly. In the recovery, postoperative room occurrence of nausea and vomiting was assessed for 24 hours. The incidence of post operative nausea and vomiting was reduced in both groups significantly but comparison between these two groups for prevention of PONV(postoperative nausea and vomiting) following elective laparoscopic cholecystectomy surgery is similar. Palonosetron has more prolonged effect than granisetron. There was no evidence of any adverse side effects and whole of the post operative period was smooth.TAJ 2011; 24(2): 118-123

Dexamethasone Reduces the Incidence of Postoperative Nausea and Vomiting in Children Undergoing Endoscopic Adenoidectomy under General Anesthesia Without Increasing the Risk of Postoperative Hemorrhage.

BackgroundPostoperative nausea and vomiting (PONV) is a common complication of pediatric anesthesia, but the overall incidence of PONV in patients undergoing adenoidectomy is unknown. The aim of this controlled study was to compare the effect of dexamethasone administration with placebo to reduce PONV in children undergoing endoscopic adenoidectomy under general anesthesia.Material/MethodsA randomized placebo-controlled study included 118 pediatric patients who underwent elective endoscopic adenoidectomy under general anesthesia. A dexamethasone-treated (0.15 mg/kg) group (Group D) (n=56) and a placebo group (Group C) (n=62) were randomly assigned. The incidence of nausea and vomiting was recorded on the day of surgery. Postoperative nausea was assessed according to illustrated Baxter Animated Retching Faces (BARF) scale. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale (scores between 0–10) was used to assess pain. Follow-up was performed on the 14th postoperative day by a telephone call.ResultsOverall prevalence of postoperative nausea was 25% (30/118) and postoperative vomiting was 14% (17/118). In the first 24 hours following surgery, in Group D, the incidence of nausea and vomiting was 13% and 7%, respectively; in Group C, without pharmacological prophylaxis, the incidence of postoperative nausea and vomiting was 37%, and 21%, respectively.ConclusionsA prospective controlled study in children undergoing endoscopic adenoidectomy under general anesthesia showed that dexamethasone (0.15 mg/kg) significantly reduced the incidence of PONV without increasing the risk of postoperative hemorrhage. Dexamethasone is a safe method for the prevention of PONV that may be recommended in pediatric anesthesiology.