Treatment Of Postoperative Nausea And Vomiting Research Articles

CHRM3 rs2165870 Polymorphism Correlates with Postoperative Nausea and Vomiting Incidence and the Efficacy of Ondansetron in a Chinese Han Population.

BackgroundPrevious GWAS studies have shown that there is a relationship between M3 muscarinic acetylcholine receptor (CHRM3) rs2165870 polymorphism and postoperative nausea and vomiting (PONV) incidence. However, no Chinese studies have addressed this issue.MethodsTo explore the relationship between CHRM3 rs2165870 polymorphism and PONV incidence in a Chinese Han population, we enrolled 512 patients receiving elective surgery in this study. CHRM3 rs2165870 polymorphism was genotyped using PCR-RFLP method.ResultsWe found that AA genotype or A allele of CHRM3 rs2165870 polymorphism elevated the risk of PONV (AA versus GG; OR, 2.88; 95% CI, 1.51–5.47; P = 0.001; A versus G; OR, 1.39; 95% CI, 1.07–1.81; P = 0.013). In addition, CHRM3 rs2165870 polymorphism was related to the risk of PONV among the males, smokers, and those individuals with Apfel Score 3–4 or ASA classification 2–3. Last, we assessed the effects of CHRM3 rs2165870 polymorphism on the treatment efficacy of ondansetron for PONV. Data uncovered that 103 of 209 patients (49.3%) showed response to ondansetron treatment for PONV. The PONV incidence was significantly higher in AA genotype carriers compared with GG genotype carriers during the first 2 h after surgery, but not from 2 to 24 h after surgery.ConclusionTo sum up, this study reveals that CHRM3 rs2165870 polymorphism is related to the incidence of PONV and treatment effects of ondansetron for preventing PONV in this Chinese Han population.

Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric populations. The guidelines are established by an international panel of experts under the auspices of the American Society of Enhanced Recovery and Society for Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019. The guidelines provide recommendation on identifying high-risk patients, managing baseline PONV risks, choices for prophylaxis, and rescue treatment of PONV as well as recommendations for the institutional implementation of a PONV protocol. In addition, the current guidelines focus on the evidence for newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT3] receptor antagonists, neurokinin 1 (NK1) receptor antagonists, and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. This set of guidelines have been endorsed by 23 professional societies and organizations from different disciplines (Appendix 1).Guidelines currently available include the 3 iterations of the consensus guideline we previously published, which was last updated 6 years ago; a guideline published by American Society of Health System Pharmacists in 1999; a brief discussion on PONV management as part of a comprehensive postoperative care guidelines; focused guidelines published by the Society of Obstetricians and Gynecologists of Canada, the Association of Paediatric Anaesthetists of Great Britain & Ireland and the Association of Perianesthesia Nursing; and several guidelines published in other languages.The current guideline was developed to provide perioperative practitioners with a comprehensive and up-to-date, evidence-based guidance on the risk stratification, prevention, and treatment of PONV in both adults and children. The guideline also provides guidance on the management of PONV within enhanced recovery pathways.The previous consensus guideline was published 6 years ago with a literature search updated to October 2011. Several guidelines, which have been published since, are either limited to a specific populations or do not address all aspects of PONV management. The current guideline was developed based on a systematic review of the literature published up through September 2019. This includes recent studies of newer pharmacological agents such as the second-generation 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, a dopamine antagonist, neurokinin 1 (NK1) receptor antagonists as well as several novel combination therapies. In addition, it also contains an evidence-based discussion on the management of PONV in enhanced recovery pathways. We have also discussed the implementation of a general multimodal PONV prophylaxis in all at-risk surgical patients based on the consensus of the expert panel.

Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patients: a Systematic Review

While guidelines exist for the management of postoperative nausea and vomiting (PONV) in the general surgical setting, there are no established guidelines for the prevention or treatment of PONV in bariatric patients, in whom PONV contributes significantly to perioperative morbidity and hospital resource utilization. This systematic review found that the multimodal pharmacological approach to PONV prevention recommended in current guidelines for high-risk surgical patients is appropriate for the bariatric subset. This includes multi-agent antiemetic prophylaxis with dexamethasone and one or more agents from other classes, and opioid-free total intravenous anesthesia, though the advantages of the latter need further evaluation. There remains a need for a standardized validated instrument to assess PONV in the bariatric setting.

Efficacy of amisulpride on postoperative nausea and vomiting: a systematic review and meta-analysis.

Postoperative nausea and vomiting (PONV) remains a significant clinical problem for surgical patients. Amisulpride is a well-studied D2/D3 antagonist that has the potential to be used for preventing and treating PONV. Our aim was to assess the efficacy and safety of amisulpride for prevention and treatment of PONV through a systematic review and meta-analysis. A systematic literature search was performed using MEDLINE, EMBASE, PUBMED, clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials from their inception to Feb 15th, 2019. The efficacy outcome was the incidence of complete response, defined as no emesis and no rescue antiemetic use in a 24-h period after study drug administration. The safety outcomes were the adverse effects associated with amisulpride. Five studies comprising 3243 patients met inclusion critieria. Compared with placebo, amisulpride showed a significantly improved incidence of complete response [relative risk (RR): 1.30; 95% confidence interval (CI): 1.20-1.41; P < 0.00001, I2= 0%] with firm evidence from the trial sequential analysis. Particularly, the amisulpride at 5mg dose indicated a significant benefit than placebo [relative risk (RR): 1.28; 95% confidence interval (CI): 1.18-1.39; P < 0.00001, I2= 4%]. The adverse event profile of amisulpride was generally similar to the placebo. Based on our findings, low-dose, intravenous amisulpride is safe and efficacious for the prevention and treatment of PONV compared to placebo. Further studies are needed to explore the optimal dose and timing. PROSPERO: CRD42019121483.

A pharmacological profile of intravenous amisulpride for the treatment of postoperative nausea and vomiting

ABSTRACT Introduction The issue of postoperative nausea and vomiting (PONV) remains important in surgical practice, contributing to patient distress, slower recovery, and increased use of healthcare resources. Many surgical patients report it to be a worse problem than the pain. New antiemetics of different classes are still needed to help manage PONV effectively, especially the treatment of established PONV after the failure of common prophylactic antiemetics such as 5-HT3-antagonists and corticosteroids. Intravenous amisulpride, a drug with a long history of safe use in oral form as an antipsychotic, has recently been approved in the US (trade name: Barhemsys) as an intravenous antiemetic for the prevention and treatment of PONV. Areas covered This review article summarizes the published data on the clinical pharmacology, safety, and efficacy of intravenous amisulpride as an antiemetic, supplemented by published data on oral amisulpride, where relevant to the intravenous form. Literature was obtained via the PubMed search terms ‘intravenous amisulpride’ and ‘amisulpride AND safety.’ Both primary and secondary pharmacology are covered, along with clinical pharmacokinetics (distribution, metabolism, and excretion). The review of clinical safety and efficacy includes data from four studies in the prevention of PONV, two in the treatment of PONV and two investigating effects on the QT interval of the electrocardiogram in healthy volunteers. Expert opinion Given the importance of sufficient PONV prevention for patients and the healthcare system, the availability of intravenous amisulpride is helpful, restoring the dopamine-antagonist class as a potential mainstay in both combination prophylaxis and treatment.

Postoperative Nausea and Vomiting: Risks, Prophylaxis, Non-Drug Alternative Methods

Nausea and vomiting are among the most common complaints in the postoperative period. The type of surgical technique and the site of intervention, as well as the anesthetic drugs and methods directly contribute to the rates of postoperative nausea and vomiting (PONV). One of the most important factors affecting the frequency of postoperative nausea and vomiting is the anesthetic drugs and methods used. Many antiemetic drugs are used to prevent postoperative nausea and vomiting. With the use of these drugs, side effects especially such as delayed recovery from anesthesia, dry mouth, undesirable changes in blood pressure and the occurrence of extrapyramidal symptoms are seen. Several antiemetic drugs are commonly used for the treatment of postoperative nausea and vomiting; including scopolamine, chlorpromazine, diphenhydramine, metoclopramide, promethazine, and ondansetron. Low-dose haloperidol and metoclopramide are effective in opioid-induced nausea and vomiting. Dexamethasone reduces the incidence of postoperative nausea in the first 6 hours after surgery. Oral intake starts in patients with severe vomiting parenteral fluid and electrolyte treatment is required. Sometimes provide may need gastric decompression with nasogastric tube. Parenteral fluid and electrolyte treatment and in severe cases gastric decompression with a nasogastric tube may be necessary. Alternative medicine such as acupuncture and acupressure can help prevent or reduce postoperative nausea and vomiting. The aim of this review is to examine the medical therapies and drug-free methods used for the treatment of PONV in the light of the literatüre

Identifying the optimal timing of preoperative electroacupuncture for postoperative nausea and vomiting and pain in patients undergoing laparoscopic gynecologic surgery: Study protocol for a randomized controlled trial

IntroductionElectroacupuncture (EA) has been shown to have antiemetic and analgesic effects; however, optimal timing for the therapy is unclear. Our study aims firstly to investigate the effectiveness and safety of preoperative EA, delivered 24 h before surgery, on postoperative nausea and vomiting (PONV) and postoperative pain in patients undergoing gynecologic laparoscopic surgery; and secondly to identify the optimal timing and dose of stimulation of preoperative EA for preventing PONV and postoperative pain. MethodsThis is a single-center, randomized, controlled, four-arm clinical trial. Participants who meet the selection criteria will be randomly assigned to one of the following four groups: Group 1 (EA delivered 24 h before surgery, n = 103), Group 2 (EA delivered 30 min before surgery, n = 103), Group 3 (EA delivered both 24 h before, and 30 min before surgery, n = 103), Group 4 (usual care, n = 103). All groups will receive routine treatment for PONV and pain. EA will be delivered at bilateral Neiguan (PC6) and Zusanli (ST36). The primary outcomes are the incidence of postoperative nausea (PON) and postoperative vomiting (POV), and pain scores at 24 h after the operation. Secondary outcomes include the incidence of PON and POV, and pain scores at 6 h, 48 h and 72 h after the operation, also the severity of PON and POV, consumption of opioid medications, Quality of Recovery-15 (QoR-15), days in hospital and time to passage of first flatus. The assessor and the treating anesthetists will be blinded from group allocation. Participants in the three EA groups are unaware of the purpose of the study. DiscussionAn understanding of optimal timing and dosage of preoperative acupuncture will facilitate the implementation of this non-drug therapy and contribute to the overall improvement of post-surgical care.

Research progress in neurokinin-1 receptor antagonist aprepitant used for postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) is a common complication after anaesthesia, which hinders the rapid recovery of patients. Aprepitant, one of neurokinin-1 (NK-1) receptor antagonists is mainly used to prevent nausea and vomiting by blocking the binding of substance P to NK-1 receptor. It has the advantages of high selectivity, strong affinity and long half-life, and its new antiemetic target provides a new choice for prophylactic treatment of PONV. This article summarize studies on the prophylaxis of aprepitant in treatment of PONV. Key words: Aprepitant; Neurokinin-1 receptor antagonists; Postoperative nausea and vomiting; Review

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.

Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a common complication following general anaesthesia. It may be associated with patient dissatisfaction, increased costs of treatment, and unintended admission to hospital.Supplemental intravenous crystalloid administration in the perioperative period may be a simple intervention to prevent PONV. To assess whether supplemental intravenous crystalloid administration prevents PONV in patients undergoing surgical procedures under general anaesthesia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), MEDLINE (1946 to August 2018), Embase (1947 to August 2018), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL; 1971 to August 2018). We searched clinical trials registers for ongoing or unpublished completed studies (August 2018), handsearched three major journals (British Journal of Anaesthesia, European Journal of Anaesthesiology, and Anesthesiology; August 2018), and conducted backward and forward citation searching of relevant articles. We included randomized controlled trials of participants older than six months undergoing surgical procedures under general anaesthesia and given supplemental perioperative intravenous crystalloids, defined as a volume larger than that received by a comparator group, to prevent PONV. We used the standard methodological procedures described by Cochrane. We included 41 studies (4224 participants). Participants underwent ambulatory or short length of stay surgical procedures, and were predominantly American Society of Anesthesiology (ASA) class I or II. There is one study awaiting classification and three ongoing studies. All studies took place in surgical centres, and were conducted in geographically diverse settings. Risk of bias was generally unclear across all domains.Supplemental intravenous crystalloid administration probably reduces the cumulative risk of postoperative nausea (PON) (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.51 to 0.75; 18 studies; 1766 participants; moderate-certainty evidence). When the postoperative period was divided into early (first six hours postoperatively) and late (at the time point closest to or including 24 hours postoperatively) time points, the intervention reduced the risk of early PON (RR 0.67, 95% CI 0.58 to 0.78; 20 studies; 2310 participants; moderate-certainty evidence) and late PON (RR 0.47, 95% CI 0.32 to 0.69; 17 studies; 1682 participants; moderate-certainty evidence).Supplemental intravenous crystalloid administration probably reduces the risk of postoperative vomiting (POV) (RR 0.50, 95% CI 0.40 to 0.63; 20 studies; 1970 participants; moderate-certainty evidence). The intervention specifically reduced both early POV (RR 0.56, 95% CI 0.41 to 0.76; 19 studies; 1998 participants; moderate-certainty evidence) and late POV (RR 0.48, 95% CI 0.29 to 0.79; 15 studies; 1403 participants; moderate-certainty evidence).Supplemental intravenous crystalloid administration probably reduces the need for pharmacologic treatment of PONV (RR 0.62, 95% CI 0.51 to 0.76; 23 studies; 2416 participants; moderate-certainty evidence).The effect of supplemental intravenous crystalloid administration on the risk of unplanned postoperative admission to hospital is unclear (RR 1.05, 95% CI 0.77 to 1.43; 3 studies; 235 participants; low-certainty evidence).No studies reported serious adverse events that may occur following supplemental perioperative intravenous crystalloid administration (i.e. admission to high-dependency unit, postoperative cardiac or respiratory complication, or death). There is moderate-certainty evidence that supplemental perioperative intravenous crystalloid administration reduces PON and POV, in ASA class I to II patients receiving general anaesthesia for ambulatory or short length of stay surgical procedures. The intervention probably also reduces the risk of pharmacologic treatment for PONV. The effect of the intervention on the risk of unintended postoperative admission to hospital is unclear. The risk of serious adverse events resulting from supplemental perioperative intravenous crystalloid administration is unknown as no studies reported this outcome. The one study awaiting classification may alter the conclusions of the review once assessed.

Involvement of leukotriene pathway in the development of sevoflurane-induced pica in rats.

We previously reported that sevoflurane-induced pica, kaolin ingestion behavior, in rats has the potential to reflect postoperative nausea and vomiting (PONV) in humans. It is well-known that corticosteroids, which inhibit both prostaglandin and leukotriene syntheses due to phospholipase A2 inhibition, are effective for reducing PONV; however, the precise mechanisms remain unclear. We investigated the involvement of the prostaglandin or leukotriene pathway in the development of sevoflurane-induced pica. We found that sevoflurane-induced pica was effectively inhibited by pretreatment with a leukotriene receptor antagonist (montelukast) or an inhibitor of 5-lipoxygenase (zileuton), rather than an inhibitor of cyclooxygenase (flurbiprofen). Furthermore, we observed that sevoflurane significantly increased urinary leukotriene excretion and 5-lipoxygenase mRNA expression in the spleen, but not hypothalamus. These results suggest that the production of leukotriene may lead to the development of sevoflurane-induced pica in rats, and that inhibition of the leukotriene pathway could be potentially useful for the treatment of PONV.

The Use of Aromatherapy in Postoperative Nausea and Vomiting: A Systematic Review

To evaluate the following question: In adult surgical patients, does the use of aromatherapy affect the incidence of nausea and vomiting postoperatively? Systematic review of research focusing on aromatherapy and the effect on postoperative nausea and vomiting (PONV) in adult surgical patients. A search of Medline, PubMed, Cumulative Index of Nursing and Allied Literature, and Cochrane Database of Systematic Reviews using specific inclusion and exclusion criteria yielded five randomized controlled trials. The overall synthesis of evidence supports the use of aromatherapy in PONV. Aromatherapy has a positive effect on PONV, and therefore should be considered as a complementary therapy or as an adjunct to antiemetic medications. Aromatherapy is one modality that should be considered as treatment for PONV in adult surgical patients. More research should be conducted to provide additional support in the use of aromatherapy for PONV. Future research could aim at standardizing a nausea scale that would provide more reliable and valid results in studies that research PONV.

CYP2D6 basic genotyping as a potential tool to improve the antiemetic efficacy of ondansetron in prophylaxis of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a common complication after anesthesia and surgery. Ondansetron is one of the most widely used drugs in the prophylaxis of PONV and is extensively metabolized in humans. In vitro metabolism studies have shown that ondansetron is a substrate for human hepatic cytochrome P450 enzymes. The cytochrome P450 (human hepatic cytochrome [CYP]) 2D6 inhibitor quinidine reduced in vitro hydroxylation of ondansetron, which indicates the important role of CYP2D6 in ondansetron metabolism. Genotyping these alleles allows the prediction of the extensive metabolizer (EM) and poor metabolizer (PM) phenotypes with approx. 90-96% accuracy. The aim of our study was to evaluate whether the pharmacological prevention of PONV with ondansetron depends on the most common CYP2D6 alleles (CYP2D6*1, *3, *4, *5, and NxN [multiplication gene]). Genotyping for the defective CYP2D6*3, CYP2D6*4 and CYP2D6*5 alleles among 93 surgical female patients was performed by polymerase chain reaction amplification and restriction fragment length polymorphism (PCR-RFLP). The genetically defined EMs and ultrarapid metabolizers (UMs) of CYP2D6 had a statistically significant (p < 0.02) higher frequency of nausea and vomiting after strumectomy (33.3%) than intermediate metabolizers (IMs) (10.3%) and PMs (0%). The relative risk (odds ratio [OR]) of PONV occurrence was 5 times higher for EMs/UMs than IMs/PMs. Our results suggest that PONV treatment with ondansetron could be improved by basic, widely available and inexpensive PCR-RFLP genetic tests.

Postoperative Nausea and Vomiting with Plastic Surgery: A Practical Advisory to Etiology, Impact, and Treatment.

Ambulatory surgery is common in plastic surgery, where many aesthetic and reconstructive procedures can be performed in hospitals, ambulatory surgery centers, or office-based surgery facilities. Outpatient surgery offers advantages to both the patient and the surgeon by increasing accessibility, flexibility, and convenience; lowering cost; and maintaining high-quality care. To optimize a patient's experience and comfort, postoperative nausea and vomiting (PONV) should be prevented. However, in those patients who develop PONV, it must be appropriately managed and treated. The incidence of PONV is variable. It is often difficult to accurately predict those patients who will develop PONV or how they will manifest symptoms. There are a variety of recommended "cocktails" for PONV prophylaxis and treatments that are potentially effective. The decision regarding the type of treatment given is often more related to provider preference and determination of side-effect profile, rather than targeted to specific patient characteristics, because of the absence of large volumes of reliable data to support specific practices over others. Fortunately, there are several tenets for the successful prevention and treatment of PONV we have extracted from the literature and summarize here. The following is a summary for the practicing plastic surgeon of the current state of the literature regarding PONV cause, risk factors, prophylaxis, and treatment that may serve as a guide for further study and practice management.

Trial to Evaluate the Effectiveness of Aromatherapy as an Alternative Treatment for PONV in PACU and Same Day Surgery

•Postoperative nausea and vomiting (PONV) is a major concern for patients having surgery under general anesthesia causing subjective distress, along with increased complications and delays in hospital discharge.•Even after receiving antiemetic medications during the surgical procedure, the patient can emerge from anesthesia with c/o PONV or after administration of pain medication. Repeated doses of antiemetics in PACU do not always bring adequate relief. Upon admission to Same Day Surgery (SDS) the patient can experience renewed or onset nausea with change in position or ambulation.•Knowledge of a convenient, cost-effective aromatherapy product used at other facilities prompts further research and a request for permission to conduct a trial of the product. The goal of the trial is to determine the product’s effectiveness for future purchase as an adjunctive therapy for PONV.

Aromatherapy: A Non-Pharmacologic Intervention for Postoperative Nausea and Vomiting

Incidence of Postoperative Nausea and Vomiting (PONV) is 15.5% among ambulatory patients at Houston Methodist Sugar Land Hospital (HMSLH) from May – June, 2015, and the unavailability of non-pharmaceutical therapy in the current PONV treatment modality.

Research progress of dexmedetomidine in prevention postoperative nausea and vomiting

Background The incidence of postoperative nausea and vomiting (PONV) ranges from 20% to 80%. Dexmedetomidine(Dex) is a potent and highly selective α2 adrenergic receptor agonist and recent studies suggest that Dex may be of vital role in prevention and treatment of PONV. Objective The effect of Dex in PONV prevention and therapy will be reviewed. Content Possible mechanisms, advantages and the best dose, application time and method of Dex in experimental studied were summarized in this review to explore the effect of Dex on the prevention and treatment of PONV. Trend Dex is expected to be a new drug option for reducing PONV. Key words: Dexmedetomidine; Prevention; Postoperative nausea and vomiting

Association of Postoperative Nausea and Vomiting Incidence With Neutrophil-Lymphocyte Ratio in Ambulatory Maxillofacial Surgery

Postoperative nausea and vomiting (PONV) constitutes an important factor in ambulatory surgery. The mechanisms of the antiemetic action of potent anti-inflammatory corticosteroids, which are used extensively for the treatment of PONV, as well as the association between PONV and inflammation, have not been investigated sufficiently. We aimed to establish the association between the neutrophil-lymphocyte ratio (NLR) and postoperative antiemetic administration, as well as to investigate whether the NLR would be a biomarker for PONV. The anesthesia records of American Society of Anesthesiologists (ASA) physical status I or II patients who underwent ambulatory routine oral surgery under general anesthesia were evaluated after we obtained ethical approval from the faculty ethics committee. A 5-point scale was used to score PONV. Metoclopramide (Metpamid, Istanbul, Turkey) was used as the first choice in patients who had a PONV scale score of 1 or higher. Data regarding metoclopramide administration during extubation and discharge periods were analyzed. Sixty-four patients were randomized and enrolled in the study with an NLR less than 2 (group I, n= 37) or an NLR greater than 2 (group II, n= 27), and metoclopramide administration was evaluated in each case. The association between the NLR and metoclopramide administration was analyzed statistically by a descriptive statistical method in detecting frequencies; the χ2 test was used in comparison of the groups and the t test in independent groups. The metoclopramide administration frequency for PONV was 5.4% in group I and 96.3% in group II. The metoclopramide administration frequency in group II was statistically higher than that in group I (P < .001). We are of the opinion that the NLR can be easily calculated with data obtained from the complete blood count and could be a marker for PONV. Antiemetic prophylaxis could be given after evaluation of the NLR. However, we suggest that this result should be supported with further prospective studies using larger series.

Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial

BackgroundA novel treatment, chewing gum, may be non-inferior to ondansetron in inhibiting postoperative nausea and vomiting (PONV) in female patients after laparoscopic or breast surgery. In this pilot study, we tested the feasibility of a large randomized controlled trial. MethodsWe randomized 94 female patients undergoing laparoscopic or breast surgery to ondansetron 4 mg i.v. or chewing gum if PONV was experienced in the postanaesthesia care unit (PACU). The primary outcome was full resolution of PONV, with non-inferiority defined as a difference between groups of <15% in a per protocol analysis. Secondary outcomes were PACU stay duration, anti-emetic rescue use, and acceptability of anti-emetic treatment. The feasibility of implementing the protocol in a larger trial was assessed. ResultsPostoperative nausea and vomiting in the PACU occurred in 13 (28%) ondansetron patients and 15 (31%) chewing gum patients (P=0.75). Three chewing gum patients could not chew gum when they developed PONV. On a per protocol basis, full resolution of PONV occurred in five of 13 (39%) ondansetron vs nine of 12 (75%) chewing gum patients [risk difference 37% (6.3–67%), P=0.07]. There was no difference in secondary outcomes between groups. Recruitment was satisfactory, the protocol was acceptable to anaesthetists and nurses, and data collection was complete. ConclusionsIn this pilot trial, chewing gum was not inferior to ondansetron for treatment of PONV after general anaesthesia for laparoscopic or breast surgery in female patients. Our findings demonstrate the feasibility of a larger, multicentred randomized controlled trial to investigate this novel therapy. Clinical trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12615001327572.

Comparative Pharmacology and Guide to the Use of the Serotonin 5-HT3 Receptor Antagonists for Postoperative Nausea and Vomiting.

Since the introduction of the serotonin 5-hydroxy tryptamine 3 (5-HT3) receptor antagonists in the early 1990s, the incidence of postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) has decreased, yet continues to be a problem for the surgical patient. The clinical application of the 5-HT3 receptor antagonists has helped define the approach and role of these antiemetics in the prevention and treatment of PONV and PDNV. Pharmacological and clinical differences exist among these medications resulting in corresponding differences in effectiveness, safety, optimal dosage, time of administration, and use as combination and rescue antiemetic therapy. The clinical application of the 5-HT3 receptor antagonist antiemetics has improved the prevention and treatment of PONV and PDNV. The most recent consensus guidelines for PONV published in 2014 outline the use of these antiemetics. The 5-HT3 receptor antagonists play an important role to help prevent PONV and PDNV in perioperative care pathways such as Enhanced Recovery After Surgery (ERAS). Comparisons and guidelines for use of the 5-HT3 receptor antagonists in relation to the risk for PONV and PDNV are reviewed.