Frequency of postoperative nausea and vomiting in patients undergoing laparoscopic foregut surgery

Abstract

Nausea after laparoscopic foregut procedures is common, occurring twice as often on the nursing unit as in the PACU. The occurrence of PONV leads to a longer hospital stay, and can result in significant sequelae requiring reoperation. The use of preoperative or intraoperative antiemetics does not alter the frequency of postoperative nausea, suggesting the need to develop effective preemptive regimens for patients undergoing laparoscopic foregut procedures. The high rate of PONV and its potential risk of damage to a fundoplication and hiatal hernia repair should lead surgeons to consider whether laparoscopic foregut procedures should ever be performed on an outpatient basis.

Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006

“…The nationwide percentage of laparoscopic antireflux surgery performed in the outpatient setting in the United States is believed to be less than 10% (C. Daniel Smith, MD, Department of Surgery, Mayo Clinic in Florida, personal communication). Patients undergoing laparoscopic antireflux surgery often develop nausea and vomiting in the first 24 hours postoperatively, which could lead to disruption of fundoplication 32 . Keeping them inpatient overnight with available intravenous antiemetics potentially lowers this risk.…”

“…Patients undergoing laparoscopic antireflux surgery often develop nausea and vomiting in the first 24 hours postoperatively, which could lead to disrup-tion of fundoplication. 32 Keeping them inpatient overnight with available intravenous antiemetics potentially lowers this risk. In addition, the decline in inpatient antireflux surgery is unlikely due to a shift toward endoscopic treatment of GERD, which is no longer approved by the Food and Drug Administration (FDA) or supported by major gastroenterology societies.…”

Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures

“…Interestingly, laparoscopic gynecological procedures have nearly an 80% incidence of PONV (6). Although the exact reasoning is unknown it has been suggested that in addition to the female gender risk factor that the increased intra-abdominal pressure used during laparoscopic procedures may be partly responsible for this dramatic increase in PONV (7).…”

Phase II Study to Evaluate the Safety and Efficacy of the Oral Neurokinin-1 Receptor Antagonist Casopitant (GW679769) Administered with Ondansetron for the Prevention of Postoperative and Postdischarge Nausea and Vomiting in High-risk Patients

“…PONV also delays discharge from the postanesthesia care unit or requires an unanticipated admission to the hospital. 6,7 In patients undergoing laparoscopic cholecystectomy, the incidence of PONV ranges up to 72% in those who have not been given prophylactic treatment for preventing PONV. 8,9 Risk-stratification analyses 10 -12 have identified four factors for predicting an increased risk for PONV: female sex, a history of motion sickness or PONV, nonsmoking status, and the use of postoperative opioids.…”