Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine

Abstract

Background The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis. Methods The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April–November 2013 (n = 59) and September 2014–June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV. Results Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk. Conclusions There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.

Retrospective Analysis of Incidence and Risk Factors of Postoperative Nausea and Vomiting after Orthopedic Surgery under Spinal Anesthesia

“…The recent prospective observational study reported female sex and a history of PONV as signi cant risk factors for PONV after spinal anesthesia [12]. Although this study did not show a signi cant association between smoking and PONV incidence due to a lack of smokers [12], our study also showed a signi cant association between them. The effect of postoperative opioid on PONV after spinal anesthesia could be estimated from previous studies regarding opioidsparing analgesia in spinal anesthesia [13], and postoperative opioid also showed a signi cant association with PONV incidence after spinal anesthesia in our study.…”

“…Our result suggested that four risk factors for PONV included in the Apfel score could be still valid for predicting PONV after spinal anesthesia [7]. The recent prospective observational study reported female sex and a history of PONV as signi cant risk factors for PONV after spinal anesthesia [12]. Although this study did not show a signi cant association between smoking and PONV incidence due to a lack of smokers [12], our study also showed a signi cant association between them.…”

Chewing Gum for Prevention of Nausea and Vomiting After Elective Caesarean Section: a Pilot Randomised Controlled Trial

“…This is perhaps due to chewing gum having no supplementary anti-emetic effect or perhaps neuraxial anaesthesia with spinal morphine playing a significant role in the incidence of PONV compared to general anaesthetic. Patients undergoing lower limb surgery under spinal anaesthesia combined with intrathecal Morphine had a similar incidence of PONV to that in our study [17]. Trials assessing the non-inferiority of chewing gum compared to Ondansetron in treatment of PONV after LSCS may shed more light on this subject.…”

Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia

“…Our result suggests that four risk factors for PONV included in the Apfel score could be still valid for predicting PONV after spinal anesthesia [ 7 ]. The recent prospective observational study reported female sex and a history of PONV as significant risk factors for PONV after spinal anesthesia [ 12 ]. This previous study did not show a significant association between smoking and PONV incidence due to a lack of smokers [ 12 ]; however, our study revealed a significant association between them.…”