Rescue Antiemetic Requirements Research Articles

Effect of patient-controlled analgesia on development of postoperative nausea and vomiting in patients undergoing microvascular decompression: a prospective randomized controlled trial.

Postoperative nausea and vomiting (PONV) occurs frequently after microvascular decompression (MVD). Fentanyl, an opioid, is strongly related to the development of PONV, and ketorolac, a nonsteroidal anti-inflammatory drug, has been approved for postoperative pain management. However, how ketorolac-based patient-controlled analgesia (PCA) causes PONV or how its efficacy differs from that of fentanyl-based PCA after MVD is unclear. In this study, the authors compared ketorolac-based with fentanyl-based PCA in terms of the incidence and severity of PONV and analgesia after MVD. This prospective, double-blind, single-center, randomized controlled trial conducted from December 2021 to February 2023 included patients with MVD who were randomly allocated to the ketorolac- or fentanyl-based PCA group postoperatively. The incidence (primary outcome) and severity of PONV and rescue antiemetic requirements were determined during the first 48 hours postoperatively. Additionally, postoperative pain scores, rescue analgesic requirement, PCA usage, and satisfaction scores were assessed during the study period. PONV severity and postoperative pain scores were assessed using an 11-point numeric rating scale (0 = none, 10 = extremely). Satisfaction scores for PONV and pain were determined (0 = very dissatisfied, 10 = very satisfied). Categorical variables were analyzed using the chi-square or Fisher's exact test. Continuous variables were analyzed using the Student t-test or Mann-Whitney U-test based on normal distribution. Of 185 screened patients, 91 were excluded based on predetermined exclusion criteria; 87 patients (43 in the ketorolac group and 44 in the fentanyl group) were analyzed and showed no significant differences in demographic data between groups. PONV incidence (48.8% vs 79.5%, p = 0.003) and severity (p = 0.004) were lower in the ketorolac-based PCA group than in the fentanyl-based PCA group. In the ketorolac group, there was a significant reduction in rescue antiemetic requirements compared with the fentanyl group (p = 0.049). The number of discontinuations was lower in the ketorolac-based PCA group than in the fentanyl-based PCA group (p = 0.001), whereas no significant differences in postoperative pain were found between the two groups. In patients with MVD, ketorolac-based PCA resulted in a decrease in PONV incidence and severity compared with fentanyl-based PCA, with analgesic effects similar to those of fentanyl-based PCA. This study provides clinical evidence that ketorolac-based PCA may be a valid alternative to fentanyl-based PCA in postoperative care.

A Meta-Analysis of Dextrose Infusion as Perioperative Strategy on Preventing Postoperative Nausea and Vomiting

Introduction: Dextrose infusion was introduced as a non-pharmacological perioperative strategy to decrease the PONV incidence. However, current published studies reported remain inconsistent and debatable results regarding the efficacy. This research was conducted to improve the evidence-based perioperative strategies of administering dextrose infusion to prevent PONV. Method: A literature search was conducted for randomized controlled trial studies (RCTs) in patients who administered dextrose infusion compared to other infusion fluid perioperatively. A quantitative analysis using Review Manager 5.4 was performed with a 95% confidence interval that was visualized in the forest plot graph using the fixed-effects or random-effects model based on the heterogeneity. Results: A total of 18 RCTs studies analyzed demonstrated there were significant differences in composite PONV (RR, 0.66, 95% CI 0.60, 0.74; P < 0.00001; I2=46%), patients with postoperative antiemetic rescue requirements (RR, 0.67, 95% CI 0.53, 0.86; P < 0.001; I2=68%), and postoperative blood glucose levels (SMD, 2.63, 95% CI 1.76, 3.50; P < 00001; I2=97%). However, there were insignificant results in PONV severity (SMD, -0.94, 95% CI -2.20, 0.31; P = 0.14; I2=97%), patients with analgesic requirements (RR, 0.84, 95% CI 0.60, 1.19; P = 0.33; I2=81%), dose of analgesic requirements (SMD, -2.31, 95% CI -5.76, 1.14; P = 0.19; I2=99%), and PACU stay (MD, -24.73, 95% CI -66.07, 16.61; P < 0.24; I2=99%). Conclusion: This meta-analysis demonstrated that administering dextrose infusion perioperatively prevents both the PONV incidence and postoperative rescue antiemetic requirements, and also increase postoperative blood glucose levels. However, dextrose infusion is not associated with reducing the PONV severity, postoperative analgesic requirements, a dose of postoperative analgesic use, and PACU stay. .

A study comparing the effectiveness of ondansetron versus ondansetron combined with dexamethasone for preventing postoperative nausea and vomiting in laparoscopic surgeries

Abstract Background: Postoperative nausea and vomiting (PONV) frequently occur as a side effect of general anesthesia, which can be intensified by the introduction of gas into the peritoneal cavity to create pneumoperitoneum during laparoscopic surgeries. Aims and Objectives: This study examines the comparative effectiveness of ondansetron as a standalone treatment versus its combination with dexamethasone in preventing PONV during laparoscopic surgeries. The research aims to assess the efficacy and duration of anti-nausea and anti-vomiting effects provided by ondansetron alone and in combination with dexamethasone. Materials and Methods: The Institutional Ethics Committee (IEC) approved the trial materials and methods following thorough deliberation. Before surgery, written informed consent was obtained from all patients. Sixty patients were recruited for the study and randomly allocated into groups, denoted as Group O and Group D, each consisting of 30 patients. Group O received intravenous administration of 4 mg of ondansetron, while Group D received a combination of 4 mg of ondansetron and 4 mg of dexamethasone intravenously 30 min before extubation. Duration of Study: The research was conducted at MGM Medical College and Hospital, located in Navi Mumbai, Maharashtra, India, from May 2016 to May 2017. Results: In this study, mild and moderate nausea were more prevalent in Group O at the 4-h mark, but there was no notable difference at 24 h. Mild and moderate retching showed no significant variance at 4 h, but Group O exhibited significantly more at 24 h. Mild, moderate, and severe vomiting were inconsequential in both groups at 4 h, but Group O showed a higher incidence of mild and moderate vomiting at 24 h. Instances of severe vomiting were absent in both groups. The need for rescue antiemetics after 24 h and medication-related side effects did not show significant differences between the two groups. Conclusion: The incidence of PONV was reduced in the combination group (ondansetron + dexamethasone) compared to ondansetron alone. Consequently, the combination group had a lower requirement for rescue antiemetics. Thus, the effectiveness of combination therapy surpassed that of ondansetron alone.

Comparison of the efficacy of acupressure on P6 point, dexamethasone and ondansetron versus palonosetron monotherapy for preventing postoperative nausea and vomiting in laparoscopic surgery

Background: Postoperative nausea and vomiting (PONV) is a common occurrence, affecting approximately 70-80% of patients who have undergone surgery, particularly those with multiple risk factors. The aim of our study was to compare the effectiveness of palonosetron as monotherapy versus a combination of ondansetron with dexamethasone and acupressure P6 wristband in preventing PONV and reducing the need for rescue anti-emetics after laparoscopic surgery. Methodology: A randomized controlled trial involving a total of 90 ASA I and II patients with APFEL scores ≥ 2 was conducted. These patients were recruited and randomly assigned to either the monotherapy or the combination therapy group. In the monotherapy group, patients received intravenous (IV) palonosetron 0.075 mg immediately after induction of anesthesia. In the combination therapy group, patients received dexamethasone 8 mg IV and an acupressure P6 wristband immediately after induction. Subsequently, ondansetron 4 mg IV was administered, and the wristband was removed prior to emergence from anesthesia. For both groups, metoclopramide 10 mg IV was available as a rescue anti-emetic if needed. The frequency of PONV and the requirement of rescue anti-emetics were recorded at multiple time points: at 0, 6, 12, 24, and 48 h postoperatively. Results: In the combination therapy group, 13.3% of patients experienced PONV, compared to 33.3% in the palonosetron group. The difference was statistically significant (95% CI 0.107-0.888, P = 0.025). The combination therapy group had a lower incidence of nausea compared to the palonosetron group, particularly at 6 h (2.2% vs 24.4%, 95% CI 0.009-0.571, P = 0.002) and at 12 h (0% vs 11.1%, 95% CI 1.696-2.662, P = 0.021). The incidence of vomiting was significantly lower in the combination therapy group at 6 h (2.2% vs 15.6%, 95% CI 0.015-1.048, P = 0.026). None of the patients in the combination therapy group required rescue anti-emetics, while 17.8% of patients in the palonosetron group requested these post-operatively. The difference was statistically significant (95% CI 1.746-2.814, P = 0.003). Conclusion: The combination therapy with ondansetron, dexamethasone and acupressure P6 wristband significantly reduced the incidence of PONV and the need for rescue anti-emetics when compared with the palonosetron alone. The benefits of the combination therapy were particularly notable at 6 and 12 h postoperatively, as evidenced by the significantly lower incidence of nausea and vomiting during these time periods. Key words: Combination Therapy; Monotherapy; Palonosetron; PONV; Rescue Anti-Emetics Citation: Zhong CW, Mokhtar AM, Nik Mohammad NA, Omar M, Azmi NM, Mazlan MZ. Comparison of the efficacy of acupressure on P6 point, dexamethasone and ondansetron versus palonosetron monotherapy for preventing postoperative nausea and vomiting in laparoscopic surgery. Anaesth. pain intensive care 2023;27(6):625−631; DOI: 10.35975/apic.v27i6.2148 Received: February 02, 2023; Revised: October 15, 2023; Accepted: November 06, 2023

Isopropyl alcohol inhalation versus 5-HT3 antagonists for treatment of nausea: a meta-analysis of randomised controlled trials

PurposeNausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings.MethodsMEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE.ResultsFrom 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low.ConclusionIPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.

Effects of aprepitant on post-operative nausea and vomiting in patients with congenital heart disease undergoing cardiac surgery or catheterization procedures: a retrospective study with subjects as their own historical control

IntroductionFor patients undergoing cardiac surgery and catheterization procedures, severe post-operative nausea and vomiting (PONV) can occur despite standard anti-emetic interventions. Aprepitant, a neurokinin-1 (NK-1) receptor blocker, is safe and effective at preventing PONV resistant to standard therapies.MethodsPatients with a history of severe PONV presenting for cardiac surgery or catheterization procedures from January 1, 2018 to January 6, 2021 were identified. After pharmacist approval, patients received aprepitant pre-operatively (Dose: 80 mg for weight >50 kg, 40 mg for weight 30–50 kg). A retrospective chart review was performed. Primary outcomes of the incidence of PONV and PONV-related complications were evaluated.ResultsSeventeen patients were included with a mean age of 16.0 years at the time of their initial procedure, which acted as the “control” procedure, and 17.5 years when they received aprepitant. After the control procedure 64.7% of patients required rescue anti-emetics. When this group of patients received aprepitant pre-operatively at their subsequent procedure, only 17.6% required rescue medication (p = 0.005). Similarly, 64.7% of patients suffered at least one PONV-related complication after the control procedure. With aprepitant use pre-operatively, 5.9% of the same patients experienced a PONV-complication (p = 0.0003). Specifically, unplanned ICU admission due to severe PONV after catheterization procedures decreased from 55.6% (5/9) in the control group to 0 after these patients were treated pre-emptively with aprepitant (p = 0.01). For surgical patients, there were significant decreases in PONV-related complications including delayed oral intake and delayed ambulation (p = 0.04) in the aprepitant group compared to the control group.DiscussionThis small, retrospective study supports the conclusion that preoperative aprepitant administration in patients undergoing cardiac catheterization or cardiac surgery with a history of congenital heart disease and severe PONV significantly reduces the incidence of PONV and PONV-related complications. Decreasing these complications will likely improve the surgical experience for patients and families while also decreasing hospital costs and improving efficiency.

Comparison between transcutaneous electrical nerve stimulation and metoclopramide in preventing postoperative nausea and vomiting after gastrointestinal laparoscopic surgery-A prospective and randomized study

Background: Postoperative nausea and vomiting is a common complication after laparoscopic surgery and general anesthesia. It increases the patient’s discomfort and compromises the surgical outcome. Aims and Objectives: The study aimed to compare the effectiveness of Transcutaneous Electrical Nerve Stimulator (TENS) and Injection of Metoclopramide for the prevention of post-operative nausea and vomiting in patients undergoing gastrointestinal laparoscopic surgery. The secondary objective of the study was to find out the percentage of cases needed rescue antiemetic drug (Inj. Ondansetron) when prophylaxis failed. Materials and Methods: The study was a prospective, double-blind, randomized trial conducted at M.G.M. Medical College and M.Y. Hospital, Indore. 90 patients of 18–60 years of age, ASA physical status I-II, undergoing elective laparoscopic gastrointestinal surgery were included. Patients were allocated randomly into two equal groups. Group T received TENS (the stimulation group) at P6 acupressure point, whereas group M received an injection of Metoclopramide before induction of anesthesia. Patients in both groups were observed for 24 h postoperatively for the incidence of nausea and vomiting and the requirement for rescue antiemetic. Results: The percentage of Postoperative Nausea Vomiting (PONV) and requirement of rescue antiemetics in both the groups were comparable in the first 6 h following laparoscopic gastrointestinal surgeries (P=1.000). There was no significant difference in PONV and rescue antiemetic requirement at 24 h in both the groups. Conclusion: TENS stimulation at P6 acupressure point is comparable to injection of Metoclopramide in preventing postoperative nausea and vomiting after laparoscopic gastrointestinal surgeries.

Evaluation of the Role of Preoperative Oral Amisulpride as Part of a Multimodal Antiemetic Prophylaxis Regime on Postoperative Nausea and Vomiting in Patients Undergoing Craniotomy: A Prospective, Double-Blind, Randomized, Placebo-controlled Study.

Patients undergoing craniotomy are at high risk for postoperative nausea and vomiting (PONV) despite the use of prophylactic antiemetics. We hypothesized that a single preoperative oral dose of amisulpride as part of a multimodal antiemetic regimen would decrease the incidence of PONV in patients undergoing craniotomy for intracranial tumor surgery. Adult patients scheduled for elective craniotomy requiring general anesthesia were enrolled and randomized to receive either oral amisulpride 25mg or placebo 2 hours before surgery in addition to our institution's usual antiemetic regimen. The primary outcome of the study was the incidence of nausea and/or vomiting during the first 24 hours postoperatively. Secondary outcomes included severity of nausea, use of rescue antiemetic medications, and treatment-related adverse events. A total of 100 patients were included in the analysis. More patients in the amisulpride group had no episodes of nausea (90% vs. 40%; P<0.001) and no episodes of vomiting (94% vs. 46%; P<0.001) compared with the placebo group. The severity of nausea was lower in the amisulpride group than in the control group in the first 4 hours after surgery (P<0.05), and fewer patients receiving amisulpride required rescue antiemetics (P<0.001). The incidence of treatment-related adverse events was similar between groups. A single preoperative oral dose of amisulpride 25mg as a component of a multimodal antiemetic regimen decreased the incidence and severity of PONV in patients undergoing craniotomy for intracranial tumor surgery, with no adverse effects.

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

BackgroundRemimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery.MethodsPatients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery.ResultsThe incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05).ConclusionsIn this study, remimazolam did not increase the incidence and severity of PONV compared with propofol.Trial registrationKCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.

Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil

BackgroudPostoperative nausea and vomiting (PONV) is one of the most common complications after total thyroidectomy under general anesthesia. Total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing total thyroidectomy. Penehyclidine, an anticholinergic agent with an elimination half-life of over 10 h, is widely used as premedication to reduce glandular secretion. This study aimed to explore the preventative effects of penehyclidine with propofol-remifentanil-TIVA to single-TIVA on PONV in patients undergoing total thyroidectomy.MethodsA total of 100 patients scheduled for total thyroidectomy were randomly assigned to either the penehyclidine group (n = 50) or TIVA group (n = 50). Propofol and remifentanil were was used for TIVA in all patients. No patients who received premedication. Patients were administrated with either 5 ml of normal saline or 0.5 mg of penehyclidine soon after anesthesia induction. The incidence of nausea and vomiting, the severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 h in two time periods (0–2 h and 2–24 h).ResultsThe overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and the incidence of vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2–24 h after surgery. However, there was no significant difference between the two groups at 0–2 h after surgery.ConclusionsAdministration of penehyclidine under TIVA with propofol-remifentanil is more effective for prevention of PONV than TIVA alone, especially 2–24 h after total thyroidectomy.Trial registrationhttps://www.chictr.org.cn/edit.aspx?pid=132463&htm=4 (Ref: ChiCTR2100050278, the full date of first registration: 25/08/2021).

Effect of Acupressure at P6 on Nausea and Vomiting in Women with Hyperemesis Gravidarum: A Randomized Controlled Trial.

Hyperemesis gravidarum is characterized by severe nausea and vomiting. This study aims to illustrate the efficacy of acupressure at P6 in treating nausea and vomiting in hyperemesis gravidarum. This parallel randomized controlled trial was conducted from 2016–2017 in a tertiary hospital. Hospitalized women with ≤16 weeks of gestation and moderate to severe nausea and vomiting classified using a modified PUQE score were randomly assigned in a 1:1 ratio to either apply an acupressure wristband at the P6 point three times daily or to receive regular doses of intravenous antiemetics. The primary outcome was differences in modified PUQE scores among the groups. The secondary outcomes were differences in the rate of urine ketone clearance and the frequency of requiring rescue antiemetics. Ninety women were equally randomized into two groups, with no dropout. There was a statistically significant difference in the degrees of nausea and vomiting between the groups at 8, 16, and 24 hours post-admission (p8hours= 0.001, p16hours = 0.006, and p24hours = 0.001). The requirement of antiemetics and the rate of urine ketone clearance between the two groups were also statistically significant, at p = 0.001 and p = 0.02 respectively. There were no side effects in either group. The P6 acupressure was efficacious in alleviating nausea and vomiting among hyperemesis gravidarum women. The trial was retrospectively registered on ClinicalTrials.gov (NCT05175079).

Comparison of Low-Dose Promethazine and Dexamethasone against Ondansetron Monotherapy Given as Antiemetic Prophylaxis during Myomectomy Under Spinal Anesthesia: A Randomized Clinical Trial.

Postoperative nausea and vomiting (PONV) prophylaxis is still inadequate for a significant proportion of women undergoing myomectomy under spinal anesthesia; and it substantially decreases patient's quality of postoperative recovery. Current protocol and practice favor the use of combination therapy like promethazine/dexamethasone for PONV prophylaxis with minimal side effects and cost advantages in low-resource climes. Methodology. Seventy American Society of Anesthesiologist (ASA) class I or II women aged 21-65 years scheduled for myomectomy were recruited and randomized into group A (promethazine/dexamethasone group) and group B (ondansetron group). Myomectomy was performed on each patient using spinal anesthesia. After induction of spinal anesthesia, patients in group A received intravenous promethazine 12.5 mg and dexamethasone 8 mg while group B received intravenous ondansetron 8 mg. Early (0-3 h) and late (4-24 h) PONV was assessed using the numerical scoring scale. Data analysis was done using SPSS version 20. Postoperatively, there was no significant difference in the incidence of early ansd late PONV (p value >0.05) despite the higher incidents in the ondansetron group. The proportion of patients who required rescue antiemetics was more in the ondansetron group when compared with the promethazine/dexamethasone, with minimal and statistically insignificant side effects in both groups. There was significant patient satisfaction in both groups. The study shows that the combination of low-dose promethazine and dexamethasone is comparable to ondansetron when used as prophylaxis for PONV with cost benefits in low-resource environments.

Antiemetic Efficacy of Prophylactic Ondansetron Versus Ondansetron with Dexamethasone Combination Therapies in Women Undergoing Breast Surgeries: A Randomized Controlled Trial

Objective: To compare the prophylactic antiemetic efficacy of ondansetron monotherapy with that of the combination of ondansetron and dexamethasone in the prevention on postoperative nausea and vomiting (PONV) in breast surgeries by observing the incidence of PONV, assess the percentage of participants requiring rescue antiemetics, know the side effects of drugs, and analyze the effect of the surgical duration of breast surgeries. Methods: The group ondansetron (O) received 0.1 mg/kg IV ondansetron and the other group (ondansetron and dexamethasone combination, OD) received 0.1 mg/kg IV ondansetron and 0.1 mg/kg of dexamethasone. The incidence of PONV in the first 24 h, percentage of population receiving rescue antiemetics, surgical duration, and hemodynamic parameters were noted. Results: In the 0 h to 6 h postoperative period, 38.9% of participants of group O had PONV, whereas only 13.9% in group OD had PONV, which was statistically significant ( P &lt; .016). About 30.6% of study population in group O and 8.3% in group OD required rescue antiemetics which was statistically significant ( P = .017). Surgical duration of more than 120 min had a statistically significant higher incidence of PONV in the O group with a P-value of .048. Conclusion: The combination of prophylactic ondansetron with dexamethasone is more efficacious than ondansetron alone for the prevention of PONV in women undergoing breast surgeries.

Comparison of palonosetron and aprepitant for prevention of post operative nausea and vomiting in females undergoing laparoscopic hysterectomy under general anesthesia

Background: Postoperative nausea and vomiting (PONV) is the second most common complaint following pain after surgery. In this era of daycare and outpatient-based surgery, PONV is the cause of delayed recovery and discharge from hospital settings. This study was designed to compare Palonosetron and Aprepitant for the prevention of PONV in patients undergoing laparoscopic hysterectomy under general anesthesia. Methods: 70 patients were included in this randomized double-blind study. Each group was allocated to receive either 0.075 mg of intravenous Palonosetron or 40mg of oral Aprepitant for PONV prophylaxis. A standard regimen of general anesthesia was administered to both groups for surgery. The primary outcome was the PONV impact severity scale (PISS) score at 48 hours following surgery in both groups. Secondary outcomes were the incidence of clinically significant PONV in both groups and the requirement of rescue antiemetics. Results: Mean PISS score at 48 hours was significantly lower (0.91±0.13 vs 3.43±0.2) in the Palonosetron group than in the Aprepitant Group. Incidence of PONV (16/35 vs 33/35) was significantly lower with Palonosetron. Incidence of clinically significant PONV and requirement of rescue antiemetics was significantly lower (2/35 vs 13/35) in the Palonosetron group.

Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery

Objective: To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting (PONV) in patients scheduled for laparoscopic surgery. Methods: A total of 86 female patients were prospectively administered dexmedetomidine 1 μg/kg i.v. (the group A, n=43), and dexamethasone 8 mg i.v. (the group B, n=43). The two groups were compared in treatment response, hemodynamic changes, and Numerical Analog Scale (NAS). Besides, the relation of PONV with patient baseline characteristics in the perioperative period was determined as well. Results: Patients in group A had lower PONV scores (t=3.1, P&lt;0.002), less needs for rescue anti-emetics (χ2=0.47, P&lt;0.001), and decreased intraoperative heart rate (t=9.72, P&lt;0.001) and mean arterial pressure (t=7.58, P&lt;0.001) compared to that of group B. Group A reported lower NAS than group B (t=2.66, P&lt;0.001). In addition, we found no relationship between PONV score and rescue anti-emetic requirement, age, or body mass index (P=0.96, P=0.60, P=0.28, respectively). Conclusion: Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries, with better efficacy than dexamethasone. Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.

A comparative clinical study of ramosetron and ramosetron with dexamethasone for the prevention of postoperative nausea and vomiting in laparoscopic surgeries

Postoperative nausea and vomiting (PONV) along with pain and shivering are frequently observed in patients recovering from surgery and general anesthesia. To compare the efficacy of Ramosetron alone and in Combination with Dexamethasone in patients undergoing laparoscopic surgeries, with respect to nausea, vomiting , requirement of rescue analgesia and antiemetics, discharge time, and also side effects.Current study was a prospective observational double-blind study conducted at a tertiary care hospital. A total of 60 ASA grade I and II patients of age group 20-50 years undergoing elective laparoscopic surgeries under general anesthesia with Body mass index between 18-25 were included in the study. Participants were divided by using a computer-generated random number table into two groups of 30 each with Group R and Group RD each consisting of 30 patients. Group R received 0.3 mg. of Ramosetron intravenous (IV) and group RD received both 0.3mg. P value &amp;#60; 0.05 was considered statistically significant. coGuide version V.1.0.3 was used for statistical analysis.The mean duration of surgery in group R was 35.83 ± 6.44 minutes and 35.66 ± 6.26 minutes in group RD. The difference in the proportion of PONV scores between the study group was statistically not significant (P value 0.982). The rescue antiemetic was used in 5 (16.67%) patients in group R and in 2(6.67%) patients in group RD. Combination therapy of Ramosetron with dexamethasone had better efficacy than Ramosetron alone in reducing PONV on patients undergoing laparoscopic surgeries.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial.

BackgroundThis study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.MethodsEighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP block. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric rating scale (NRS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded.ResultsSeventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NRS than those in group C (P < 0.05). The highest difference in the postoperative NRS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores.ConclusionsIn patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NRS and reduced analgesic requirements than port site LAI.

Efficacy of Palonosetron and Dexamethasone for Prevention of Post-operative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Randomised Double-Blind Trial.

Post-operative nausea and vomiting is a frequent complication following anaesthesia. We compared the efficacy and safety of intravenous palonosetron and intravenous dexamethasone as prophylactic antiemetic in patients undergoing laparoscopic cholecystectomy. After obtaining institutional ethical committee approval, 100 adult female patients undergoing laparoscopic cholecystectomy were randomised to receive 4mg dexamethasone (group I, n ¼ 50) or 0.075 mg palonosetron (group II, n ¼ 50) intravenously (IV) over 2-5 minutes prior to induction of anaesthesia. Standard anaesthetic technique was followed, and the residual neuromuscular block was antagonised at theend of the procedure. A single anaesthesiologist assessed all the cases for post-operative nausea and vomiting (PONV) for 24 hours. The complete response rate and the overall patient satisfaction were noted. If patient experienced PONV, injection metoclopramide 10 mg was given as rescue antiemetic IV. A total of six patients had vomiting within 6 hours (four patients in groups I and two patients in group II), whereas none had vomiting after 6 hours (P ¼ .39). Complete response rate was 88 and 90% in both group I and group II. Three patients in both group I and group II required rescue antiemetics. Ninety-two percent patients were completely satisfied in group I, while 96% patients were fully satisfied in group II. Intravenous administration of palonosetron (0.075 mg) is as effective as dexamethasone (4 mg) as prophylactic antiemetic without any untoward side effects for female patients undergoing laparoscopic cholecystectomy.

Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting.

Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.

Cutoff Values for Providing the Ideal Intravenous Patient-Controlled Analgesia According to the Intensity of Postoperative Pain-A Retrospective Observational Study.

Background and Objectives: The cutoff values were analyzed for providing the ideal intravenous patient-controlled analgesia (PCA) that could reduce rescue analgesics or antiemetics requirements, based on the grades of postoperative pain intensity (PPI). Materials and Methods: PCA regimens of 4106 patients were retrospectively analyzed, and they were allocated into three groups with low, moderate, and high PPI grades (groups L, M, and H, respectively) based on numeric rating scores obtained 6 h postoperatively. Opioid and non-opioid analgesic doses were converted into fentanyl-equivalent doses (DOSE-FEN-OP and DOSE-FEN-NONOP, respectively). The primary endpoint was the cutoff values of these parameters. Results: With respect to the PCA settings to reduce rescue analgesic and antiemetic requirements, group L required a background infusion rate (BIR) of 1.75–3 mL/h, bolus volume of 0.5–1.25 mL, and lockout interval of ≤12.5 min. Group M required a BIR of 1.75 mL/h, bolus volume of 0.5–1.75 mL, and lockout interval of ≤5 min. Group H required a BIR of 1.75 mL/h, bolus volume of 0.5 mL, and lockout interval of ≤5 min. In assessments of the analgesic doses to reduce rescue analgesic requirement, the DOSE-FEN-OP was at least 950 μg of fentanyl regardless of group, while the DOSE-FEN-NONOP was ≥250 μg, ≥550 μg, and ≥700 μg for the L, M, and H groups, respectively. In assessments of the analgesic doses to reduce rescue antiemetic requirement, DOSE-FEN-OP was ≤950 μg for groups L and M and ≤850 μg for Group H, while DOSE-FEN-NONOP was ≤50 μg, ≤450 μg, and ≤700 μg for groups L, M, and H, respectively. Conclusion: The ideal PCA for reduction in rescue analgesics or antiemetics can be achieved by adjustment of PCA settings and drug dosages carefully with these cutoff values depending on the expected grades of PPI. Especially, the ideal PCA can be provided by adjusting the lockout interval and bolus volume rather than BIR and by applying smaller bolus doses and shorter lockout intervals with an increasing PPI grade.