Gastric Negative Pressure Suction Method Reduces the Incidence of PONV after Orthognathic Surgery

Wang, Jia; Zhang, Zhenzhen

doi:10.3389/fsurg.2022.882726

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…These factors may cause bias and influence the reliability of the result. Furthermore, a retrospective study of Wang et al [ 57 ] analyzed 772 patients to discuss the relationship between gastric negative pressure suction and the incidence of PONV after orthognathic surgery. Their results revealed that the incidence of PONV was halved when patients received gastric negative pressure suction.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

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Introduction Postoperative nausea and vomiting (PONV) is one of the most common adverse events following orthognathic surgery. It’s a distressing feeling for patients and continues to be the cause of postoperative complications such as bleeding, delayed healing, and wound infection. This scoping review aims to identify effective PONV prophylaxis strategies during orthognathic surgery that have emerged in the past 15 years. Methods We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from 2008 to May 2023. Studies meeting the following criteria were eligible for inclusion: (1) recruited patients undergo any orthognathic surgery; (2) evaluated any pharmacologic or non-pharmacologic method to prevent PONV. Studies meeting the following criteria were excluded: (1) case series, review papers, or retrospective studies; (2) did not report our prespecified outcomes. Results Twenty-one studies were included in this review. Pharmacological methods for PONV prevention include ondansetron and dexamethasone (3 studies), peripheral nerve block technique (4 studies), dexmedetomidine (1 study), pregabalin (2 studies), nefopam (2 studies), remifentanil (1 study), propofol (2 studies), and penehyclidine (1 study). Non-pharmacologic methods include capsicum plaster (1 study), throat packs (2 studies) and gastric aspiration (2 studies). Conclusions Based on current evidence, we conclude that prophylactic antiemetics like dexamethasone, ondansetron, and penehyclidine are the first defense against PONV. Multimodal analgesia with nerve block techniques and non-opioid analgesics should be considered due to their notable opioid-sparing and PONV preventive effect. For the non-pharmacological methods, throat packs are not recommended for routine use because of their poor effect and serious complications. More prospective RCTs are required to confirm whether gastric aspiration can prevent PONV effectively for patients undergoing orthognathic surgery.

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Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

View full text Add to dashboard Cite

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“…Moreover, a recent retrospective study with a large-scale sample also determined its effects on reducing the incidence of POV and operation time in orthognathic surgery. [ 19 ] They declared that the clinical benefits of gastric aspiration were not only reflected in reducing POV but also may prevent POV from the original source, such as reducing the operation time. Another clinical observational investigation also supported the utilization of gastric aspiration in ear, nose, and throat surgery because of the lower incidence and severity of PONV after gastric aspiration application.…”

Section: Discussionmentioning

confidence: 99%

“…However, at the same time, indwelling gastric tubes may also stimulate the pharynx and larynx, although they are not a continuous catheterization in oral and maxillofacial surgery. [ 19 ] In addition, the method of gastric tube insertion could be another factor influencing POV. Erkalp et al argued that the orogastric method would be more effective than the nasogastric method due to easier and fewer pharyngology-related complications, which may be a potential interfering factor of POV.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, observational studies with larger scales exhibited different conclusions compared with ours. [ 19 , 33 ] Although we excluded nonRCTs due to their low-quality, we still need to draw conclusions with caution. Moreover, the included trials contained multiple confounding factors, such as subspecialty surgical procedures, and subgroups could not be performed due to insufficient comparisons.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 , 6 , 11 ] Its clinical efficacy was apparently supported by some clinical studies with respect to the reduction of POV after oral and maxillofacial procedures. [ 19 ] However, as the first traceable randomized controlled trial (RCT), Jones et al [ 20 ] denied the clinical efficacy of gastric aspiration in reducing POV. Since then, multiple clinical trials and observations have been conducted to identify the pros and cons of gastric aspiration for oral and maxillofacial operations, but debates have remained until now.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of gastric aspiration in reducing postoperative vomiting after oral and maxillofacial surgery: A meta-analysis

Zhang,

Xie,

Shi

et al. 2024

Medicine

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Background: Gastric aspiration is applied in oral and maxillofacial procedures to reduce postoperative vomiting (POV), yet its clinical benefit remains largely uncertain. Our study aimed to determine the role of gastric aspiration in the amelioration of POV by a meta-analysis. Methods: With adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, global recognized databases, including PubMed, Embase, and Cochrane Central, were searched to obtain randomized controlled trials (RCTs) investigating the effects of gastric aspiration in oral and maxillofacial surgery. The incidence and the number of episodes of POV and the frequency of rescue antiemetic use were extracted as parametric data for pooled estimation. Funnel plots and Egger’s test were utilized to assess bias. The recommendation of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: After detailed evaluation, 5 RCTs containing 274 participants were eventually included. The results of pooled estimation indicated that gastric aspiration could not reduce the incidence of POV (risk ratio [95% CI] = 0.94 [0.73, 1.21], P = .621), the number of episodes of POV (standard mean difference [95% CI] = −0.13 [−0.45, 0.19], P = .431) or the frequency of rescue antiemetic use (RR [95% CI] = 0.86 [0.49, 1.52], P = .609). No publication bias was detected by the funnel plot and Egger test. The overall recommendation of evidence was rated low regarding each outcome. Conclusion: Based on current evidence, gastric aspiration is not recommended for oral and maxillofacial surgery. Meanwhile, more large-scale high-quality RCTs are needed.

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An Enhanced Recovery After Surgery (ERAS) Protocol for Orthognathic Surgery Reduces Rates of Postoperative Nausea

Alvarez,

Hebert,

Britt

et al. 2024

Journal of Craniofacial Surgery

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For many surgical procedures, enhanced recovery after surgery (ERAS) protocols have improved patient outcomes, particularly postoperative nausea and vomiting. The purpose of this study was to evaluate postoperative nausea following orthognathic surgery after the implementation of an ERAS protocol. This retrospective cohort study included patients between 12 and 35 years old who underwent orthognathic surgery at Boston Children’s Hospital from April 2018 to December 2022. Patients with syndromes or a hospital stay greater than 48 hours were excluded from the study. The primary predictor was enrollment in our institutional ERAS protocol. The main outcome variable was postoperative nausea. Intraoperative and postoperative covariates were compared between groups using unpaired t tests and chi squared analysis. Univariate and multivariate regression models with 95% confidence intervals were performed to identify predictors for nausea. A P value<0.05 was considered significant. There were 128 patients (68 non-ERAS, 60 ERAS) included in this study (51.6% female, mean age 19.02±3.25 years). The ERAS group received less intraoperative fluid (937.0±462.3 versus 1583.6±847.6 mL, P≤0.001) and experienced less postoperative nausea (38.3% versus 63.2%, P=0.005). Enhanced recovery after surgery status (P=0.005) was a predictor for less postoperative nausea, whereas bilateral sagittal split osteotomy (P=0.045) and length of stay (P=0.007) were positive predictors for postoperative nausea in multivariate logistic regression analysis. Implementing an ERAS protocol for orthognathic surgery reduces postoperative nausea. Level of Evidence: Level III—therapeutic.

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Gastric Negative Pressure Suction Method Reduces the Incidence of PONV after Orthognathic Surgery

Cited by 4 publications

References 16 publications

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

The efficacy of gastric aspiration in reducing postoperative vomiting after oral and maxillofacial surgery: A meta-analysis

An Enhanced Recovery After Surgery (ERAS) Protocol for Orthognathic Surgery Reduces Rates of Postoperative Nausea

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