An update on the management of postoperative nausea and vomiting

Cao, Xun; White, Paul F.; Ma, Hong

doi:10.1007/s00540-017-2363-x

Cited by 146 publications

(103 citation statements)

References 82 publications

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“…PONV is a very common complication following opioid-based intravenous PCA 26 . PONV can cause dehydration, electrolyte imbalance, postoperative bleeding, wound dehiscence, and pulmonary aspiration, and further aggravate patient discomfort.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Luo

et al. 2020

Sci Rep

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Poor postoperative pain control impairs patient recovery and lengthens the duration of hospitalization after various surgeries. Local infiltration analgesia(LIA) has become an effective method for managing postoperative pain. This study aimed to investigate the efficacy of LIA with ropivacaine for postoperative pain control after cervical laminoplasty. In total, 68 patients undergoing cervical laminoplasty were included for retrospective review and divided into ropivacaine and control groups. The visual analogue scale (VAS) score, postoperative analgesic consumption, operative duration, intraoperative blood loss volume, incision length, hospitalization duration and incidence of complications were analyzed. In the ropivacaine group, the VAS score was 3.2 ± 1.4 at 4 hours postoperatively, which was lower than that of the control group(4.0 ± 1.4, P = 0.024). At 8, 12 and 24 hours after surgery, a significant difference was detected in the VAS score between the two groups(P ≤ 0.015). Sufentanil consumption was less in the ropivacaine group than in the control group in the first 4 hours postoperatively (25.6 ± 6.3 µg vs 32.2 ± 6.8 µg, P < 0.001), and similar results were observed in the first 8, 12, 24, 48 and 72 hours postoperatively(P < 0.001). Fewer patients required rescue analgesia in the ropivacaine group(8/33 vs 18/35 at 4-8 hours, P = 0.021; 9/33 vs 21/35 at 8-12 hours, P = 0.007). The hospitalization duration and time to ambulation were shorter in the ropivacaine group(8.5 ± 1.4 vs 9.6 ± 1.6 for postoperative duration, P = 0.002; 2.9 ± 0.7 vs 3.5 ± 0.8 for time to ambulation, P = 0.001). The incidence of nausea and vomiting was lower in the ropivacaine group than in the control group(30.3% vs 54.3%, P = 0.046). In conclusion, LIA with ropivacaine could effectively reduce postoperative pain, and postoperative analgesic consumption, and promote recovery after cervical laminoplasty. Cervical laminoplasty has been used widely and achieved satisfactory outcomes in treating multilevel cervical lesions, including cervical spondylotic myelopathy(CSM), congenital cervical stenosis(CCS), and ossification of the posterior longitudinal ligament(OPLL) 1-3. However, surgical treatment often results in serious pain, which can impair patient recovery and lengthen the hospitalization duration. Recently, local infiltration analgesia (LIA) has emerged as a good choice for postoperative analgesia due to its simplicity and low-cost 4,5. LIA has been used in various surgeries with favorable outcomes and without major side effects 6. The benefits of LIA in spinal surgery are also well known; however, its use has been limited to lumbar decompression and discectomy, and spinal fusion surgery 7,8. Few studies have focused on the effect of LIA on postoperative pain control in cervical laminoplasty. Therefore, we conducted this clinical study to retrospectively evaluate the efficacy of LIA with ropivacaine for managing postoperative pain after cervical laminoplasty.

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Section: Discussionmentioning

confidence: 99%

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Luo

et al. 2020

Sci Rep

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“…Early postoperative rehabilitation is affected by PONV(6),and the incidence of PONV varies from 20-80% (7,8) and is affected by surgical time, sex, and postoperative opioid (9). As the proportion of woman is quite high in rheumatoid patients, they are expected to be at high risk for PONV.…”

Section: Discussionmentioning

confidence: 99%

Impeding factors of early rehabilitation postoperatively after rheumatoid toe arthroplasty: a retrospective cohort study

Goto¹,

Kasuya²,

Okuyama³

et al. 2020

Preprint

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Background: It is important to promote early ambulation postoperatively but there are many factors that can hinder the possibility of walking after surgery. Studies have been done to research the benefits related to early ambulation postoperatively but few are focused on patients that have rheumatoid arthritis (RA). We retrospectively investigated the incidence and predictors of the inability to start walking on the first postoperative day (POD) after rheumatoid toe arthroplasty.Methods: RA patients who underwent toe arthroplasty at an academic teaching hospital were retrospectively reviewed. We divided patients into the two groups: possible group, who were able to walk on the first day postoperatively and impossible group, who were unable to walk on the first day postoperatively. The primary outcome was odds ratio (OR) with a 95% confidence interval (CI) between various patient factors and the impossible group with logistic regression analysis. The post hoc analysis for association between anesthesia methods and postoperative outcome was carried out.Results: A total of 300 patients were included and divided into two groups: possible group (n = 191) and impossible group (n = 109). The incidence of postoperative nausea and vomiting (PONV) before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22-4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block (PNB) was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04-1.59, P = 0.003], [OR = 0.41, 95% CI 0.20-0.79, P = 0.010], respectively. In the post hoc analysis, incidence of PONV was highly associated with postoperative intravenous continuous opioid (48.7%, P < 0.0001) compared to regional analgesia; PNB (11.3 %) and epidural (26.7%).Conclusions: In our study, the incidence of PONV and inadequate postoperative pain management hindered early rehabilitation. Adding PNB to general anesthesia had an advantage for postoperative rehabilitation and decreased PONV after rheumatoid toe surgery.

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“…Contemporary literature points to the fact that female sex possesses a strong predictive factor for the occurrence of PONV [14], and a high incidence of PON and POV is expected. In addition to sex, the type of surgical intervention in terms of gynecological laparoscopic surgery also influences the highly expected incidence of PONV, up to 80% [3]. For ethical reasons, this study did not include a control group that would receive a placebo, and the total incidence of PON and POV remains only at prediction level.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that patients regard vomiting as the most undesirable complication of anesthesia and qualify it as a more unpleasant sensation than pain [1,2]. The incidence of PONV in adult population is 30% [3], and in high-risk population such as gynecologic and laparoscopic surgery, it can be up to 80% [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…patient related factors (female sex, age, positive anamnesis for PONV, kinetosis, non-smoker status, the patient's American Society of Anesthesiologists (ASA) status, positive anamnesis for migraine, menstrual cycle phase); 2. surgery related factors (length of surgery, type of surgery); 3. anesthesia related factors (inhalation anesthetics, intravenous anesthetics, opioids, muscle block reversal, anesthetic technique and N 2 O); 4. early postoperative period related factor (pain, opioid administration, postoperative movement of patients, early fluid and food ingestion and hypotension) [6]. The most used antiemetic drugs used in PONV prevention and therapy include dopamine receptor antagonists, serotonin 5-HT 3 receptor antagonists, and corticosteroids [7,8].…”

Section: Introductionmentioning

confidence: 99%

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

Bagi¹,

Bagi²,

Bagi³

et al. 2019

Srp Arh Celok Lek

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

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An update on the management of postoperative nausea and vomiting

Cited by 146 publications

References 82 publications

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Impeding factors of early rehabilitation postoperatively after rheumatoid toe arthroplasty: a retrospective cohort study

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

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