Reduction Of Nausea Research Articles

The Effect of Giving Mint Decoction of Mint Leaves on the Reduction Of Nausea And Vomiting In First Trimester Pregnant Women at The Puskesmas Cipondoh Of Tangerang

The first trimester of pregnancy is the formation that starts from the conception of the ovum with a sperm cell. Pregnancy is the process of conception that is complete with gestational age at 1 week to 12 weeks during pregnancy. In the first trimester of pregnancy a woman experiences complaints of nausea, vomiting. Pregnant women who experience nausea and vomiting can consume decoction of mint leaves because mint leaves contain essential oils which can help relieve nausea and vomiting. The purpose of this study was to determine the effect of mint leaf decoction on the reduction of nausea and vomiting in first trimester pregnant women at Puskesmas Cipondoh of Tangerang. This study used quantitative research with quasi-experimental research methods with one group pretest-posttest design. The sample in this study amounted to 10 respondents, selected through purposive sampling. Data retrieval was done using the Pregnancy Unique Quantification of Emesis And Nausea (PUQE) questionnaire to measure nausea and vomiting. Data analysis used the Wilcoxon statistical test with a confidence level of 95%. The results of this study found that there was an effect of giving decoction of mint leaves to a decrease in nausea and vomiting in first trimester pregnant women in Puskesmas Cipondoh Kota Tangerang with p value= 0.008 (p < 0.05). The conclusion of this study is that giving mint leaves boiled for three days can reduce nausea and vomiting in pregnant women. This research can be recommended to add the number of samples so that they can be made into two intervention groups and control groups so that they can be used as comparative materials. Researchers expect health workers to be able to implement therapy to reduce nausea and vomiting by using mint leaves. Keywords: Mint leaves, Pregnancy, Nausea vomiting

Efficacy of Acupressure on Nausea and Vomiting in Children Undergoing Chemotherapy: A Systematic Review

Background: Chemotherapy is the main component of systemic cancer treatment; however, the effective application is restricted due to nausea and vomiting. We aimed to assess the effect of acupressure on nausea and vomiting in children undergoing chemotherapy. Materials and Methods: An extensive search was done in databases of Medline, Embase, Scopus, Cochrane, and Web of Science until February 2018. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: Four studies were included in the systematic review (including 223 children and adolescents aged 5 to 19 years). The first study assessed the effect of acupressure wrist bands and placebo bands; the results showed the feasibility of well tolerated acupressure, but not more effective than placebo. In the second study, researchers concluded that the acupressure bands compared to sham bands could not improve nausea and vomiting, neither in the acute nor the delayed phase. In addition, daily vomiting was not improved via acupressure bands in either the acute, or the delayed phases in chemotherapy. In the third study, a significant difference was observed between the two groups auricular acupressure intervention+ standard care (AAP), and auricular acupressure using sham auricular points (SAP) + standard care regarding occurrence, and severity of both nausea and vomiting. The results of fourth study showed that acupressure has a significant role in the reduction of nausea, vomiting and retching associated with chemotherapy among adolescents with cancer. Conclusion: The patients considered the acupressure as a safe, effective and well-received strategy though objective criteria exhibited no statistically significant improvements compared to conventional care.

Comparison of the Prophylactic Effect of Ondansetron, Dexamethasone, and the Combination of These Drugs on Decreasing Nausea and Vomiting in Children Aged 1 to 12 Years Old Undergoing Upper Gastrointestinal Endoscopy

Background: Endoscopy is a diagnostic and therapeutic method with a high risk of nausea and vomiting. Considering the lack of adequate studies on the prevention of postoperative nausea and vomiting after endoscopy in children, this study was conducted to compare the effects of ondansetron, dexamethasone and a combination of these drugs on the reduction of nausea and vomiting in children aged 1 to 12 years undergoing upper gastrointestinal endoscopy. Methods: In this double-blind, randomized clinical trial, 146 children aged 1 to 12 years, undergoing upper gastrointestinal endoscopy were randomly allocated to four groups of 36. Before endoscopy, the groups received 0.1 mg / kg of ondansetron, 0.2 mg / kg dexamethasone, a combination of the two drugs and placebo, respectively. Results: According to the results of our study, children who underwent upper GI endoscopy, administration of ondansetron plus dexamethasone was associated with a significantly lower frequency of nausea in all assessment time points. However, the difference between the groups was significant only on admission to recovery and the 15 minutes after admission to recovery (P<0.001). Conclusion: The results of our study indicated that in children undergoing endoscopy, the use of ondansetron plus dexamethasone is associated with reduction in the incidence of nausea and vomiting, and the use of the combination does not cause significant side effects compared to ondansetron, dexamethasone or placebo, separately.

Effectiveness of P6 Stimulation for Reduction of Nausea and Vomiting During Caesarean Section Under Combined Spinal-Epidural Anaesthesia: A Randomised Controlled Trial.

Obstetric patients who receive combined spinal-epidural (CSE) anaesthesia for elective caesarean section (CS) frequently experience intraoperative nausea and vomiting (N&V). Prophylactic therapy with antiemetic agents can have multiple adverse effects to the mother and baby. We designed a randomised clinical trial to evaluate the efficacy of electrical P6 stimulation for prophylactic N&V treatment for scheduled elective CS performed under CSE anaesthesia. Following the Institutional Review Board approval and informed consent, a total of 180 patients were randomly allocated into three groups: (1) P6 stimulation (via a peripheral nerve stimulator), (2) intravenous (IV) antiemetics (metoclopramide and ondansetron), and (3) control (no IV antiemetic medications and no P6 stimulation), with 60 parturients in each group. Significantly fewer patients experienced intraoperative N&V in the P6 group (nausea 36.7% and vomiting 13.3%) and IV antiemetic group (nausea 23.3% and vomiting 16.7%) than those in the control group (nausea 73.3% and vomiting 45%; p<0.001). In addition, significantly fewer patients required rescue antiemetic medications in the P6 group (35%) and the IV antiemetic group (31.7%) than those in the control group (73.3%; p<0.001). There was no significant difference in the overall anaesthetic care satisfaction reported between the three study groups. Our data suggest that P6 stimulation is as simple and as effective as our routine prophylactic IV antiemetic treatment for prevention of N&V during CS performed under CSE anaesthesia that could be of great interest to patients and obstetric anaesthesiologists who prefer treatments with fewer potential side effects.

Gut-directed hypnotherapy versus standard medical treatment for nausea in children with functional nausea or functional dyspepsia: protocol of a multicentre randomised trial

IntroductionThe treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in...

An investigation into the effect of gabapentin capsules on the reduction of nausea and vomiting after chemotherapy in cancerous patients under platinum-based treatment.

Introduction and Objective:Chemotherapy-induced nausea and vomiting (CINV) is a condition that occur in most patients. This study aimed to investigate the effect of gabapentin capsules on the reduction of chemotherapy-induced nausea and vomiting in patients admitted in the hematological ward for adult patients with platinum-based treatment.Materials and Methods:The present study was a randomized clinical trial, which consisted of a control group and an experimental one. The study population consisted of 126 women and men with colonic and gastric cancer who were admitted to Ahwaz Shafa Hospital of adult hematology ward. Of these, 120 subjects were eligible to enter the study. Immediately after chemotherapy, gabapentin capsules were taken. Up to 72 hours later, nausea and vomiting were compared. Descriptive statistics was used to investigate the demographic characteristics. Paired t-test, independent t-test and ANOVA were used to compare the results.Results:The results showed that most of the patients had gastric cancer in the experimental (70%) and control group (66.66%). The results also showed that chemotherapy-induced nausea and vomiting in gabapentin recipient group was different from the placebo group. Accordingly, chemotherapy induced nausea and vomiting in gabapentin group was lower than the placebo group.Conclusion:Post-operative nausea and vomiting is an unpleasant experience. Today, the patients find it worse than pain, and they believe it is hard to afford the cost of treatment. Gabapentin seems to be a good drug for reducing nausea and vomiting.

CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S

Event Abstract Back to Event CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S David J. Clark1* 1 Carrick Institute, United States Background: A 45 year old woman presented with severe fatigue, poor appetite, mental fog and nausea. She also suffered sleep disturbances characterized by waking after 4 to 5 hours of sleep, and alternately, difficulty falling asleep until 2:00 AM. Her history was significant for previous diagnosis of alopecia universalis and hypothyroidism. She was taking Concerta®, Zoloft® and levothyroxine. Her diet was unrestricted and notable for appearing hypocaloric. Methods: Ingestion of Th1 cytokine boosters provoked her symptoms. Blood chemistry revealed low vitamin D (21.7 ng/mL), vitamin B12 (226 pg/mL) and high thyroid peroxidase antibodies (220 IU/mL), eosinophil percentage (17%), absolute eosinophils (0.9), cholesterol (236 mg/dL), HDL (105 mg/dL), homocysteine (16.8 umol/L) as well as clinically significantly low folate (7.6 ng/mL), T3 (87 ng/dL), and ferritin (47 ng/mL). She was placed on an anti-inflammatory diet and supplement protocol utilizing turmeric, resveratrol, sublingual vitamin D, sublingual glutathione, folinic acid, hydroxocobalamin, and a multi-nutrient formula to support glucose utilization. Results: After 30 days, she reported 80% improvement in sleep, 60% improvement in fatigue, 90% improvement in appetite (reduction in nausea). She continued on the same protocol for an additional 30 days, and reported complete resolution of fatigue, mental fog and poor appetite. She began running for exercise. Blood chemistry retest showed normal levels of vitamin B12, folate, ferretin and vitamin D. Conclusion: The author recommends further investigation into the use of diet and supplementation in the treatment of patients with chronic fatigue and sleep problems. Keywords: Hashimoto's autoimmune thyroiditis, chronic fatigue, Anti-inflammatory diet, supplementation, Sleep disturbance Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00037 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Unilateral paravertebral block guided by nerve stimulator with a single-level injection for ipsilateral hernioplasty using 0.5% levobupivacaine Hcl versus 2% hyperbaric prilocaine Hcl

Background Thoraco-lumbar paravertebral blockade (PVB) provides the best alternative for anesthesia in lower abdominal surgeries owing to minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. Aim This study was designed to compare two local anesthetics drugs, levobupivacaine Hcl 0.5% versus hyperbaric prilocaine Hcl 2%, used in PVB-guided nerve stimulator. Patients and methods A total of 60 American Society of Anesthesiologists I and II patients scheduled for elective unilateral open technique hernioplasty under regional anesthesia using ipsilateral thoraco-lumber PVB technique were divided into two groups. Patients were randomly assigned to receive a single injection of thoraco-lumbar PVB-guided nerve stimulator with local anesthetic 20 ml in total volume, levobupivacaine Hcl 0.5% (group L) (n=30) and hyperbaric prilocaine Hcl 2% (group HP) (n=30), at 12 thoracic vertebra (T12), with a catheter inserted in PV space. Parameters measured were onset and offset time of anesthesia and motor block, hemodynamics evaluation, numeric rating scale for pain assessment, blood glucose level, cortisol level, interleukin 6 level, time of first voiding, patient satisfaction, postoperative complications, and first 24-h postoperative morphine consumption. Results There was statistically significant longer time of onset of sensory block and motor regression in group L than group HP. Patient stress response was highly significantly lower in each group when compared between values at T0 and T1, whereas the response was significantly lower in HP group only at T1 but insignificantly at T2. Postoperative morphine consumption was significantly higher in group L than group HP only at T0, whereas was insignificant in T1, T2, T3, T4, T5, and T6 postoperatively. Conclusion PVB is a highly efficient anesthetic technique with lesser complications than general or regional anesthesia.

Prophylatic efficacy of dexamethasone, ketamine and dexmedetomidine against intra- and postoperative nausea and vomiting under spinal anesthesia

Background: This study aims to compare the prophylactic effects of dexamethasone, ketamine, and dexmedetomidine versus normal saline on intra- and postoperative nausea and vomiting (PONV) associated with cesarean section (CS) under spinal anesthesia. Materials and Methods: A double-blind prospective clinical trial was performed on 140 patients scheduled for elective CS and was assigned randomly to four groups. The first group received 20 cc normal saline; the second group received dexamethasone at a dose of 0.1 mg/kg; the third group received ketamine at a dose of 0.5 mg/kg; and the fourth group received IV dexmedetomidine (1 μg/kg). Nausea and vomiting score was measured by visual analog scale and sedation levels by Ramsay sedation scale (RSS). Results: There was a significant difference among the four groups in PONV scores immediately after and 1, 2, 3, and 4 h following administration of the drug (P = 0.001). Nausea and vomiting score was the lowest in the dexmedetomidine group. Significant differences were observed in Ramsey score at the 10th–110th min following administration, and the dexmedetomidine group had a higher RSS than the other groups. The incidence of metoclopramide intervention in three experimental groups is comparable. Heart rate (HR) and mean blood pressure show decreasing trend following spinal anesthesia in dexmedetomidine group. Conclusion: The tested groups (dexamethasone, dexmedetomidine, and ketamine) all present a lower incidence of nausea and vomiting than the placebo group. In addition, dexmedetomidine provides the best efficacies in the reduction of nausea and vomiting but is more liable in lowering blood pressure and HRs. We recommend that dexmedetomidine is the drug of choice in decreasing nausea and vomiting for patients undergoing CS with spinal anesthesia.

Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.

Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.

The effect of Benson’s muscle relaxation technique on severity of pregnancy nausea

Introduction:Nausea and vomiting caused by pregnancy significantly affect the quality of life of pregnant women and cause problems in them. The aim of this study was to evaluate the effect of muscle relaxation technique on nausea during pregnancy.Materials and Methods:This study was a controlled clinical trial. 44 pregnant women referred to the health center were randomly divided into two groups: control and test. Benson’s muscle relaxation was taught to the test group during three sessions. They were then asked to do relaxation for 15-20 minutes for one month twice a day. No training was provided for the control group. The severity of nausea was compared using visual analogue vomiting (VAS) in two groups and the obtained results were analyzed using Wilcoxon, Kruskal-Wallis and Mann-Whitney tests at a significant level of ≤0.05.Results:Based on obtained results, 39.1% of mothers were aged between 30-35 years old. The mean and standard deviation of severity of nausea in the intervention (test) group before Benson relaxation was 6.9 ± 2.9 and after relaxation was 6.64 ± 1.99. Analysis (Mann-Whitney test) of severity of nausea before and after intervention in the test group showed a significant difference.Conclusion:Considering the positive effect of Benson’s relaxation on the reduction of nausea and vomiting in pregnancy, its education is recommended for all pregnant women in the first trimester of pregnancy in health and counseling centers.

Minimum Effective dose of Dexamethasone in Combination with Midazolam as Prophylaxis against Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy.

Background:Postoperative nausea and vomiting (PONV) affects 20% and 30% of patients. As many as 60%–80% patients at high risk may be affected. Dexamethasone (D) and midazolam (M) are well studied as antiemetic. Use of D can be associated with certain undesirable side effects so minimum dose is preferred. M is a routinely used premedicant. Hence, this study was designed with both D and M in high risk patients for PONV to find minimum effective dose of D.Aims:To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy (LC) in patients at high risk for PONV.Setting and Design:This is a prospective, randomized double-blind trial.Materials and Methods:One hundred and fifty-five patients scheduled for elective LC were randomized to 5 groups of 31 each. Group C was given normal saline, and the rest were administered D 1 mg (group MD1), 2 mg (group MD2), 4 mg (group MD4), or 8 mg (group MD8) in combination with 0.04 mg/kg M at induction. The incidence of nausea, vomiting, severity of nausea, and the use of rescue antiemetic and postoperative pain was analyzed.Statistical Analysis:Chi-square test was used to compare incidence of study variables. Independent Student's t-test was used for continuous variables. Demographic data were compared using ANOVA. P < 0.05 was considered statistically significant.Results:The incidence of nausea was significantly lower in group MD4 (29%) and MD8 (6%) compared to placebo group (71%) (P < 0.001) and of vomiting was significantly lower in groups of MD2 (58%), MD4 (48%), and MD8 (6%) compared with placebo (90%) (P < 0.001) at 24 h. There was significant reduction in nausea, pain severity, and incidence of use of rescue antiemetic in MD4 and MD8 groups with no discernable side effects of the drugs.Conclusion:We conclude that 4 mg D with M and 2 mg D with M is effective for prevention of nausea and vomiting, respectively, in patients at high risk for PONV undergoing LC.

Evaluation of thoracolumbar interfascial plane block for postoperative analgesia after herniated lumbar disc surgery: A randomized clinical trial.

Background:Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves.Objective:The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy.Methodology:This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation.Results:TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, P < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, P < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation.Conclusion:TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.

Cannabidiolic acid methyl ester, a stable synthetic analogue of cannabidiolic acid, can produce 5-HT1A receptor-mediated suppression of nausea and anxiety in rats.

The aim of this study was to compare the abilities of cannabidiolic acid methyl ester (HU-580) and cannabidiolic acid (CBDA) to enhance 5-HT1A receptor activation in vitro and produce 5-HT1A -mediated reductions in nausea and anxiety in vivo. We investigated the effects of HU-580 and CBDA on (i) activation by 8-hydroxy-2-(di-n-propylamino)tetralin of human 5-HT1A receptors in CHO cell membranes, using [35 S]-GTPγS binding assays, (ii) gaping by rats in acute and anticipatory nausea models, and (iii) stress-induced anxiety-like behaviour, as indicated by exit time from the light compartment of a light-dark box of rats subjected 24h earlier to six tone-paired foot shocks. HU-580 and CBDA increased the Emax of 8-hydroxy-2-(di-n-propylamino) tetralin in vitro at 0.01-10 and 0.1-10nM, respectively, and reduced signs of (i) acute nausea at 0.1 and 1μg·kg-1 i.p. and at 1μg·kg-1 i.p., respectively, and (ii) anticipatory nausea at 0.01 and 0.1μg·kg-1 , and at 0.1μg·kg-1 i.p. respectively. At 0.01μg·kg-1 , HU-580, but not CBDA, increased the time foot-shocked rats spent in the light compartment of a light-dark box. The anti-nausea and anti-anxiety effects of 0.01 or 0.1μg·kg-1 HU-580 were opposed by the 5-HT1A antagonist, WAY100635 (0.1mg·kg-1 i.p.). HU-580 is more potent than CBDA at enhancing 5-HT1A receptor activation, and inhibiting signs of acute and anticipatory nausea, and anxiety. Consequently, HU-580 is a potential medicine for treating some nausea and anxiety disorders and possibly other disorders ameliorated by enhancement of 5-HT1A receptor activation.

Aprepitant Has Mixed Effects on Nausea and Reduces Other Symptoms in Patients With Gastroparesis and Related Disorders

There are few effective treatments for nausea and other symptoms in patients with gastroparesis and related syndromes. We performed a randomized trial of the ability of the neurokinin-1 receptor antagonist aprepitant to reduce symptoms in patients with chronic nausea and vomiting caused by gastroparesis or gastroparesis-like syndrome. We conducted a 4-week multicenter, double-masked trial of 126 patients with at least moderate symptoms of chronic nausea and vomiting of presumed gastric origin for a minimum of 6 months. Patients were randomly assigned to groups given oral aprepitant (125 mg/day, n= 63) or placebo (n= 63). The primary outcome from the intention-to-treat analysis was reduction in nausea, defined as a decrease of 25 mm or more, or absolute level below 25 mm, on a daily patient-reported 0-to-100 visual analog scale (VAS) of nausea severity. We calculated relative risks of nausea improvement using stratified Cochran-Mental-Haenszel analysis. Aprepitant did not reduce symptoms of nausea, based on the primary outcome measure (46% reduction in the VAS score in the aprepitant group vs 40% reduction in the placebo group; relative risk, 1.2; 95% CI, 0.8-1.7) (P= .43). However, patients in the aprepitant group had significant changes in secondary outcomes such as reduction in symptom severity (measured by the 0-5 Gastroparesis Clinical Symptom Index) for nausea (1.8 vs 1.0; P= .005), vomiting (1.6 vs 0.5; P= .001), and overall symptoms (1.3 vs 0.7; P= .001). Adverse events, predominantly mild or moderate in severity grade, were more common in aprepitant (22 of 63 patients, 35% vs 11 of 63, 17% in the placebo group) (P= .04). In a randomized trial of patients with chronic nausea and vomiting caused by gastroparesis or gastroparesis-like syndrome, aprepitant did not reduce the severity of nausea when reduction in VAS score was used as the primary outcome. However, aprepitant had varying effects on secondary outcomes of symptom improvement. These findings support the need to identify appropriate patient outcomes for trials of therapies for gastroparesis, including potential additional trials for aprepitant. ClinicalTrials.gov no: NCT01149369.

Low-Dose Naloxone for Prophylaxis of Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis.

To determine whether postoperative administration of low-dose intravenous naloxone decreases the incidence of postoperative nausea and vomiting (PONV) and its impact on postoperative opioid requirements and pain scores. Meta-analysis of nine randomized controlled trials. A total of 946 adult and pediatric patients who received low-dose intravenous naloxone for 24 hours after various surgeries. Systemic literature searches of the Cochrane Central Register of Controlled Trials, Evidence-Based Medicine Reviews, PubMed, and Ovid MEDLINE databases were conducted. Among the relevant studies, data extraction and bias assessment determined the trials for inclusion in this meta-analysis. Nine randomized controlled trials met inclusion criteria. Naloxone demonstrated a reduced risk of postoperative nausea (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.67-0.95, p=0.01) in a pooled analysis of eight of the nine studies. However, naloxone did not decrease the risk of postoperative vomiting in a collective assessment of all nine trials (RR 0.83, 95% CI 0.63-1.09, p=0.18). Subgroup analysis of continuous-infusion naloxone found further reductions in nausea and vomiting, but these findings were limited to 186 of the 946 patients. Three studies recorded antiemetic doses and found an overall dose reduction (RR 0.64, 95% CI 0.42-0.96, p=0.03). Compared with controls, naloxone prophylaxis of PONV did not significantly change cumulative postoperative opioid needs (mean difference 0.29 mg, 95% CI -3.55 to 4.13 mg, p=0.88) among five trials, nor visual analog scale pain scores (mean difference -0.11, 95% CI -0.26 to 0.05, p=0.18) in six studies. This pooled analysis of data suggests that low-dose naloxone plays no role in preventing PONV, while exhibiting no significant effects on postoperative opioid needs and pain scores. The reduction demonstrated in postoperative nausea did not translate into decreases in postoperative vomiting.

The effectiveness of ibuprofen and lorazepam combination therapy in treating the symptoms of acute Migraine: A randomized clinical trial.

BackgroundMigraine is a common, episodic and debilitating disease. The migraineur not only suffers from pain, but also lives with a diminished to poor quality of life. Several medicinal therapies are used to abate the debilitating symptoms of this disease.ObjectiveThe present study was conducted to determine the effectiveness of Ibuprofen and Lorazepam combination therapy in treating the symptoms of acute migraine.MethodsThe present randomized clinical trial study used the pretest-posttest design with three comparison treatments, to examine 90 patients with an average of two to six attacks per month and an initial diagnosis of migraine based on the International Headache Society (HIS) criteria. The study was conducted on patients during the first half of 2014 with a diagnosis of acute migraine attack who were referred to Babol Ayatollah Rouhani Hospital in Iran. The patients were randomly divided into three groups of 30. The first group was administered 200 mg Ibuprofen capsules, the second group 400 mg Ibuprofen capsules and the third group a combination of 200 mg Ibuprofen capsules and 1 mg Lorazepam tablets. The medications were taken in the presence of the researcher. A checklist was used to assess the severity of headache and other migraine symptoms such as nausea, vomiting, photophobia and phonophobia in the patients, before and two hours after the intervention. Data were analyzed in SPSS-18 using the Mann-Whitney test, the McNemar test, Wilcoxon’s test, the NOVA and the Chi-squared test at the significance level of p<0.05, and power analysis with 30 patients in each group to perform this study was 0.8(1-β).ResultsThe mean age of participants was reported as 52±8 years and the condition was more frequent in women (56%). All three treatment regimens reduced the severity of headache significantly in the patients (p<0.001); nevertheless, the combination therapy used, produced the lowest mean severity of headache (p<0.001). The highest reduction in nausea and vomiting was (3.3%). None of the patients in either of the three groups reported phonophobia after the intervention, but only the patients in the combination therapy group reported no instance of photophobia.ConclusionsGiven the greater effectiveness of combination therapy with Ibuprofen and Lorazepam in alleviating the symptoms of acute migraine compared to single-drug treatments with Ibuprofen, Lorazepam is recommended to be used as a first line treatment for acute migraine.Clinical trial registrationThe trial was registered at the Thai Clinical Trials Registry (TCTR) (http://www.clinicaltrials.in.th/) with the ID: TCTR20160927003.FundingThe authors received no financial support for the research, authorship, and/or publication of this article.

Determination of the concentration of major active anti-emetic constituents within commercial ginger food products and dietary supplements

IntroductionStudies suggest that the bioactive compounds contained within the rhizome of ginger (Zingiber officinale) could exert a beneficial effect on the symptoms of several chronic conditions (e.g. diabetes, arthritis) and in the reduction of nausea. However, it is unknown if ginger supplements and food products contain sufficient quantities of the necessary active ingredients to achieve a therapeutic effect.This study analyzed twenty commercially available ginger products including ginger dietary supplements, ginger spices (ground dried ginger), and ginger-containing drinks and food products and determined the concentration of [6]-, [8]- and [10]- gingerol and [6]- and [10]-shogaol. MethodsThe samples were extracted prior to separation by Reversed Phase-High Performance Liquid Chromatography (RP-HPLC) and detected by ultraviolet (UV) spectrophotometry. ResultsConsiderable variation between individual items within each food type was observed. Per gram, ginger supplements, particularly the standardized extracts, contained the greatest concentration of measured compounds (10.08 ± 7.92 mg, mean ± standard deviation), while the concentration of compounds within spices (9.29 ± 6.73 mg), beverages (1.77 ± 1.06 mg), confectionery (0.43 ± 0.32 mg), and teas (0.13 ± 0.00 mg) was considerably lower. When the concentration of compounds was measured per standardized serve, four ginger confectionery and beverage products contained total gingerol and shogaol concentrations that were similar to the analyzed dietary supplement. ConclusionOf the twenty commercially available ginger products examined, those with the highest content of active, antiemetic constituents were the standardized ginger extracts and supplements although ginger spices also showed high levels of active constituents per serve. In addition, standard deviation reveals a large variation within each product type.

Aromatherapy for the treatment of PONV in children: a pilot RCT.

BackgroundPostoperative nausea and vomiting (PONV) is one of the most common postoperative complications of general anesthesia in pediatrics. Aromatherapy has been shown to be effective in treating PONV in adults. Given the encouraging results of the adult studies, we planned to determine feasibility of doing a large-scale study in the pediatric population.MethodsOur group conducted a pilot randomized controlled trial examining the effect of aromatherapy on post-operative nausea and vomiting in patients 4–16 undergoing ambulatory surgery at a single center. Nausea was defined as a score of 4/10 on the Baxter Retching Faces Scale (BARF scale). A clinically significant reduction was defined as a two-point reduction in Nausea. Post operatively children were administered the BARF scale in 15 min internals until discharge home or until nausea score of 4/10 or greater. Children with nausea were randomized to saline placebo group or aromatherapy QueaseEase™ (Soothing Scents, Inc, Enterprise, AL: blend of ginger, lavender, mint and spearmint). Nausea scores were recorded post intervention.ResultsA total of 162 subjects were screened for inclusion in the study. Randomization occurred in 41 subjects of which 39 were included in the final analysis. For the primary outcome, 14/18 (78 %) of controls reached primary outcome compared to 19/21 (90 %) in the aromatherapy group (p = 0.39, Eta 0.175). Other outcomes included use of antiemetic in PACU (control 44 %, aromatherapy 52 % P = 0.75, Eta 0.08), emesis (Control 11 %, 9 % aromatherapy, P = 0.87, Eta = 0.03). There was a statistically significant difference in whether subjects continued to use the intervention (control 28 %, aromatherapy 66 %, p-value 0.048, Eta 0.33).ConclusionAromatherapy had a small non-significant effect size in treating postoperative nausea and vomiting compared with control. A large-scale randomized control trial would not be feasible at our institution and would be of doubtful utility.Trial registrationClinicalTrials.gov NCT02663154.

Local anaesthetic wound infiltration for postcaesarean section analgesia: A systematic review and meta-analysis.

Wound infiltration with local anaesthetics has been investigated as a potentially useful method for providing analgesia after caesarean delivery, but the literature is inconclusive. The objective is to assess the efficacy of local anaesthetic wound infiltration in reducing pain scores and opioid consumption in women undergoing caesarean delivery. Systematic review of randomised controlled trials with meta-analyses. MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled trials (CENTRAL) until December 2015. Randomised controlled trials that assessed the efficacy of local anaesthetic wound infiltration using an infusion or single injection technique for postcaesarean section analgesia. A total of 21 studies were included in the final analysis (11 studies using an infusion technique and 10 studies using single infiltration). Local anaesthetic wound infiltration significantly decreased opioid consumption at 24 h [mean difference -9.69 mg morphine equivalents, 95% confidence interval (CI), -14.85 to -4.52] and pain scores after 24 h at rest (mean difference -0.36, 95% CI, -0.58 to -0.14) and on movement (mean difference -0.61, 95% CI, -1.19 to -0.03). Subgroup analysis did not suggest a difference in primary outcomes between infusions and single infiltration. Opioid consumption was reduced in patients who did not receive intrathecal morphine but not in those who received intrathecal morphine, although there were very little data in patients receiving intrathecal morphine. Pain scores at rest and on movement at 24 h were reduced with catheter placement below the fascia but not above the fascia. There were no statistically significant reductions in nausea, vomiting or pruritus with local anaesthetic infiltration. Local anaesthetic wound infiltration reduces postoperative opioid consumption but had minimal effect on pain scores and did not reduce opioid-related side-effects in women who had undergone delivery by caesarean section. The review is limited by a paucity of studies using intrathecal morphine and by the indirect comparisons performed for subgroup analyses.