Nausea and vomiting in the postoperative patient‐controlled analgesia environment

Abstract

SummaryDespite common clinical opinion that patient-controlled analgesia should be renamed 'patientcontrolled nausea', there is little evidence in support of the notion that postoperative nausea and vomiting are exacerbated by the method. Indeed, data indicate that opioid-sparing techniques are not associated with less postoperative nausea and vomiting. Although some evidence suggests that certain opioids are less emetogenic than others, this too does not stand scrutiny when compared across patients, although research is still required to find whether individual patients are better treated with a particular opioid. Similarly, the emerging practice of combining anti-emetics with patient-controlled analgesia needs wider study before it can be supported. Nausea and vomiting are distressing adverse events which frequently follow surgery. The incidence of postoperative nausea and vomiting is difficult to estimate because of methodological differences between studies; however, there are reports of from 8% to 92% of postsurgical patients experiencing postoperative emesis [1]. Lerman [2] and Watcha & White [3] suggest that the incidence of postoperative nausea and vomiting has remained fairly constant for decades with Ϸ20-30% of patients suffering from these unpleasant side-effects. However, it is common to find reports of a much higher incidence in a variety of surgical populations [4][5][6][7][8][9][10]. Differentiation of opioidinduced nausea and vomiting from that of other perioperative factors, including those associated with uncontrolled pain [11], is difficult enough without complications introduced by patient-controlled analgesia (PCA) which allows patients to medicate on irregular and inconsistent bases. This review focuses on the issues associated with nausea and vomiting as encountered in the postoperative PCA environment.

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones

“…The most common complication was immediate postoperative vomiting. This distressing symptom is most frequently due to anesthetics and analgesics and, in almost all cases, disappears spontaneously within 6–24 h [16, 17]. In our study, no patient vomited for more than 48 h. Fever observed in our patients was possibly due to pulmonary atelectasis.…”

Effects of Electroacupuncture on Intraoperative and Postoperative Analgesic Requirement

“…1 The reasons could be due to the short-term antiemetic effect (not more than six hours) of a single session of acupuncture; 21 female gender and gynaecological operations are known to be associated with a higher incidence of PONV; 29 and the use of morphine via PCA is also a continued emetic stimulus. 30 In summary, our results indicate that preoperative EA has a short-term morphine sparing effect postoperatively, lasting not beyond 12 hours postoperatively. The procedure was well tolerated and was generally well received by the patients.…”

Patient-controlled analgesia combined with either ondansetron or ondansetron plus prochlorperazine for control of pain and nausea and vomiting in patients undergoing abdominal surgery

“…The addition of nonsteroidal antiinflammatory drugs to an opioid PCA mixture did not appreciably reduce the frequency of PONV, even though the total opioid amount was reduced. Other research has shown that opioid use within the first 12 hours after surgery produced no difference in frequency of PONV compared with the second 12 hours, when less opioid is used [21]. If PONV was truly opioid-dependent, it would be reduced during the second 12-hour period [22].…”

“…Woodhouse et al [21] suggested that PCA opioids may play less a role in PONV than is commonly thought. The addition of nonsteroidal antiinflammatory drugs to an opioid PCA mixture did not appreciably reduce the frequency of PONV, even though the total opioid amount was reduced.…”