Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

Jin, Zhaosheng; Gan, Tong J.; Bergese, Sergio D.

doi:10.2147/tcrm.s256234

Cited by 39 publications

(29 citation statements)

References 126 publications

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“…PONV is a common side effect reported at a rate of 30% to 80% after surgeries, but it should not be overlooked, as patients may be at discomfort or this could lead to longer hospital stay or readmission. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

Kim

Seo

et al. 2022

Medicine

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Background: Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic cholecystectomy. Although PONV is usually mild, severe thing can delay recovery and prolong hospitalization. We aimed to investigate the effects of ramosetron and esmolol, alone and in combination, on PONV, and pain. Methods: We enrolled 165 patients in their 20s to 50s who had an American Society of Anesthesiology physical status score of 1 or 2 and were scheduled to undergo laparoscopic cholecystectomy. They were randomly allocated into 3 groups: groups R, E, and E+R. Patients in group R received 0.3 mg of ramosetron following surgery. Those in group E were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation. They were continuously infused with esmolol during the surgery to maintain their heart rate at 60 to 100 beats per minute and mean blood pressure at 60 to 100 mm Hg, followed by a bolus of esmolol (1.0 mg/kg) following surgery. Patients in group E+R were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation, infused esmolol during surgery, and administered 0.3 mg of ramosetron and a bolus of esmolol (1.0 mg/kg) following surgery. We monitored the PONV stages (none, nausea, retching, and vomiting) and symptom severity in 3 postoperative stages (0–30 minutes, 30 minutes to 6 hours, and 6–24 hours), the latter by using the visual analog scale (VAS). We conducted an analysis of variance to compare VAS scores between groups. Results: Patients in groups E (mean ± standard deviation VAS score, 3.62 ± 1.00) and E+R (3.66 ± 0.71) exhibited less pain (P < .05) until 30 minutes following surgery compared to group R (5.72 ± 1.41). More patients in group E (28/50, 56%) experienced nausea compared to those in groups R (15/50, 30%) and E+R (8/50, 16%) until 30 minutes after surgery (P < .05). However, there were no differences in the severity of retching and vomiting between the groups in any of the phases (P > .05). Conclusion: Despite reducing pain after laparoscopic cholecystectomy, esmolol did not prevent PONV, whether used alone or in combination with ramosetron.

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Section: Discussionmentioning

confidence: 99%

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

Kim

Seo

et al. 2022

Medicine

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“…The ERAS multimodal approach includes a limited-fasting pre-surgery protocol, allowing patients to eat solid food up to 6 h before surgery and clear liquids up to 2 h before surgery. Anti-nausea prophylactic drugs should be given systematically (a combination of aprepitant, dexamethasone, and scopolamine patch), as well as opioid avoidance [ 7 , 39 , 40 ]. Furthermore, patients are encouraged to eat soon after surgery to promote gastrointestinal function [ 8 , 41 ].…”

Section: Gastrointestinal Functionmentioning

confidence: 99%

Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

Sivaloganathan

Blakeney

Vendittoli

2022

JCM

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Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols.

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“…A number of factors, including the patient's demographics and the surgery type, influence the risk of PONV. Some surgeries, such as gynecologic, breast, and open-heart surgery, have been associated with an increased risk of PONV [65], whereas patient risk factors include female gender, nonsmoking, a history of PONV, and motion nausea [66]. Weibel et al evaluated the quality of evidence for the effectiveness and safety of single-antiemetic drugs and combinations of antiemetic drugs used to prevent postoperative nausea and vomiting in adults following general anesthesia [67] and discovered high-certainty evidence of clinical efficacy compared to placebo for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron; moderate certainty evidence of.…”

Section: Postoperative Nausea and Vomitingmentioning

confidence: 99%

The Use of Evidence-Based Acupuncture: Current Evidence

Ardinata¹

2022

Complementary Therapies

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Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

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Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

Cited by 39 publications

References 126 publications

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

The Use of Evidence-Based Acupuncture: Current Evidence

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