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Laparoscopic procedures have the advantages of minimal incision, early recovery, lesser post-operative pain and early ambulation. However, they are associated with an increased incidence of post-operative nausea and vomiting (PONV), which is all the more frequent in gynaecological laparoscopic surgeries. In our study, we have evaluated the effectiveness of intra-operative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy.METHODSInformed consent was obtained and patients were randomly divided into two groups. Group 1 received 30 mL/Kg intravenous crystalloid infusion intra operatively and group 2 received 15 mL/Kg intravenous crystalloid infusion. Incidence of nausea, incidence of emesis (retching or vomiting), the amount of rescue antiemetic used, and the haemodynamic parameters were noted in the postoperative period for 12 hours for both the groups.RESULTSIncidence of PONV was much more in group 2 in 0, 1, 2, 3, 4, 6 hours post operatively and rescue antiemetic use was much more in group 2 in total 12 hours post-operative period. There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2.CONCLUSIONSIntra-operative administration of 30 mL/Kg of crystalloid infusion significantly reduces the incidence of PONV and rescue antiemetic use compared to 15 mL/Kg crystalloid infusion in diagnostic gynaecological laparoscopy. So, it can be used as a non-pharmacological method for prophylaxis of PONV.
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Post-Operative Nausea and Vomiting (PONV) “the little big problem” after surgery/anaesthesia is a common side-effect which compromises the quality of care, delays discharge and thereby delays resumption of activities of daily living. A number of pharmacological agents (antihistamines, butyrophenones, dopamine receptor antagonists) have been used, and the 5‑hydroxytryptamine type 3 receptor antagonists have been found to be effective in prevention and treatment of PONV. Thus, we compared the prophylactic effects of intravenously administered ondansetron, palonosetron, and granisetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery under general anaesthesia. METHODSThis prospective, double blind study, comprising of 135 patients of ASA physical status I and II of either gender, was carried out after approval was obtained from the Institutional Ethical and Scientific Committee. Patients were randomized into three equal groups. Group P received inj. palonosetron (0.075 mg), group O received inj. ondansetron (8 mg), and group G received inj. granisetron (2.5 mg) intravenously five minutes before induction of anaesthesia. The episodes of postoperative nausea and vomiting, severity of nausea, need for rescue antiemetic, side effects and patient satisfaction were observed in the study groups for 24 hours in the post-operative period. At the end of study, results were compiled, and statistical analysis was done using ANOVA, chi‑square test, and Kruskal Wallis Test. Value of p < 0.05 was considered significant.RESULTSThe incidence of PONV was significantly less in the palonosetron group (95.6%) as compared to the ondansetron group (80%) and granisetron group (73.3%), with a lesser need for rescue antiemetic in the palonosetron group. All the three study groups did not have significant adverse effects reflecting that all the three drugs were well-tolerated. Patient satisfaction score was also more with palonosetron
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Background: Post-operative nausea and vomiting continues to be a common side effect of surgery and anaesthesia, affecting the economics of medical care, as well as the degree of patients’ satisfaction, comfort and quality of life.The objective of the present study were to compare the efficacy and safety of palonosetron versus placebo for prophylaxis of early onset (within 24 hours post-surgery) and late onset (24-72 hours post-surgery) post-operative nausea or vomiting in patients undergoing elective major surgery under general anaesthesia.Methods: A prospective, randomized, parallel group, two arm, double blind placebo controlled trial was conducted on n=100 indoor patients undergoing elective major surgeries were enrolled into the present study.Results: The patients showing complete response were 32 (64%) in palonosetron group and 19 (38%) in the placebo group (p<0.05) in the 0-24 hour time interval. The patients receiving palonosetron showed higher complete response rates in the 0-24 hour and 0-72 hour time intervals. 42 patients (84%) on palonosetron and 30 (60%) on placebo showed complete control of vomiting in 0-24 hour period. Adverse events related to the drug were reported in 5 patients (10%) in palonosetron group as compared to 3 patients (6%) in placebo group.Conclusions: A single prophylactic 0.075 mg IV dose of palonosetron effectively reduced the occurrence and severity of nausea and vomiting and delayed the time to emesis and treatment failure in the early as well as the overall postoperative period of 72 hours.
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Enhanced recovery after surgery (ERAS) protocols termed as “fast track surgery” have now become an essential componentin the perioperative period to improve post-operative outcomes. It is both the patient and the health services who receive thebenefits of ERAS. It is a new and different approach when compared to traditional practices which aims at enhanced care ofsurgical patients. It includes pre-operative, intraoperative, and post-operative components which when applied altogether givebest possible results. Effective implementation of ERAS protocols is associated with fast recovery of gut function and reducedrate of complications. All these factors further lead to decreased post-operative hospital stay, thereby decreasing hospital costand increasing patient satisfaction.
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Objective To investigate the effect of the different phases of menstrual cycle on the incidence of post-operative nausea and vomiting (PONV)after laparoscopic gynecological surger-ies.Methods A total of 228 women undergoing laparoscopic gynecological surgeries were enrolled from Mar 2016 to Feb 2017 in our hospital.They were classified into three groups according to the different phases of menstrual cycle at the time of surgeries:group follicular phase (n =98),group o-vulatory phase (n =79),and group luteal phase (n =59).The incidence of PONV and the use of res-cue antiemetic drugs were recorded within 0-2 h,0-24 h periods after surgeries.Multivariate Logistic regression analysis was applied to identify independent risk factors of PONV.Results The incidence of 0-2 h PONV and 0-24 h PONV were 23.2% (53/228)and 54.8% (125/228)respectively.Univa-riate analysis showed that the incidence of PONV in the different phases of menstrual cycle was not statistically significant,as well as 0-24 h.Multivariate logistic regression analysis showed that the risk of 0-2 h PONV in group luteal phase might be higher than that in group follicular phase,however, the difference was not statistically significant (OR =2.289,95%CI 0.979-5.355,P =0.056).And two independent risk factors of 0-2 h PONV were identified:duration of operation > 1 h (OR =3.176,95% CI 1.567-6.436,P = 0.001 )and history of PONV (OR = 5.711,95% CI 1.710-19.080,P =0.005).Three independent risk factors of 0-24 h PONV were identified:duration of op-eration>1 h (OR = 2.714,95%CI 1.525-4.829,P = 0.001 ),postoperative PCA (OR = 2.717, 95%CI 1.233-5.986,P = 0.013 )and application of metronidazole (OR = 3.926,95%CI 1.808-8.527,P =0.001).Conclusion There was no significant effect of different phases of menstrual cycle on the incidence of nausea and vomiting after gynecologic laparoscopic surgeries.
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Objective To observe the clinical curative effect of Ginger Vinegar Mud sticking on Shenque acupoint on postoperative nausea and vomiting (PONV) aftertotal hip/knee arthroplasty (THA/TKA), which can provide the basis for application of Ginger Vinegar Mud treatment. Methods A total of 80 patients who used the general anesthesia, were chosen according to the stochastic indicator method. They were divided into the experimental group and the control group with 40 cases in each group.The patients in both groups were given routine drug treatment and nursing according to the THA/TKA clinical pathway, based on this, the experimental group used Ginger Vinegar Mud to stick Shenque acupoint, while the control group was given dressings of the same appearance. The incidence of PONV was recorded 0-8 h, 9-12 h,13-24 h after surgery respectively. Results The incidence of nausea and vomiting in the experimental group 0-8 h was 25%(10/40), 15%(6/40),9-12 h was 20%(8/40), 10%(4/40),13-24 h was 10%(4/40), 0. While in the control group, they were 55%(22/40), 30%(12/40);40%(16/40), 25%(10/40); 30% (12/40) and 15%(6/40) respectively. The difference between the two groups was statistically significant (χ2 =58.23-80.23, P<0.05). Conclusions Using Ginger Vinegar Mud to stick Shenque acupoint can reduce the incidence rate of PONV under general anesthesia, the effect is distinct and this method is worthy of clinical promotion.
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Background: Gabapentin has been used in perioperative setting for the management of post-operative pain for surgery performed under general anaesthesia. Post-operative nausea and vomiting (PONV) even with the use of newer agents remains a major problem. The primary aim of this study was to see if gabapentin use decreased PONV. Methods: A total of 40 patients undergoing elective laparoscopic cholecystectomy under general anesthesia with standardized premedication and anesthetics were randomized to receive gabapentin or a matching placebo. The patients in Group I received gabapentin 600 mg orally 2 hrs before surgery and 12 hrs after the first dose. The patients in Group II received a matching placebo orally 2 hrs before surgery and 12hrs after the first dose. Patients in both groups received diclofenac sodium 75 mg i.m b.i.d for pain and ondensetron 4 mg i.v for PONV. Additional doses were given on demand and recorded. The treatment was double blinded. Results: The present study did not find significant reduction in PONV score and antiemetic consumption in gabapentin group when compared to a placebo for a period of 24 hrs. Conclusions: Gabapentin in the doses used was found to ineffective in post-operative nausea and vomiting in patients undergoing planned laparoscopic cholecystectomy with standardized pre-anaesthetic and anaesthetic medication.
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Background: Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of PONV. Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to evaluate the efficacy of prophylactic ondansetron in LSCS patients given spinal anaesthesia. Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were received ondansetron 4mg i.v. 3-5min before surgery. Episodes and severity of nausea, vomiting and retching were noted at the end of 1st, 2nd, 6th and 24th hr. Results: The mean age, weight and duration of surgery was not significantly different when compared group-A parturiants with group-B. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreasing as postoperative time progresses. Conclusion: The present study suggests that prophylactic ondansetron 4mg is more efficacious in preventing post operative nausea and vomiting in LSCS under spinal anaesthesia.
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BACKGROUND: We compared the incidence and degree of post-operative nausea and vomiting (PONV) in patients who received general anesthesia with propofol or sevoflurane using the Rhodes index of nausea, vomiting, and retching (RINVR) to assess the degree of PONV quantitatively and objectively during the post-anesthetic period. METHODS: We performed a prospective study involving 38 patients who underwent gynecologic laparoscopic surgery in our hospital between September 2008 and August 2009. Nineteen patients were anesthetized with propofol during the entire anesthetic period and the other 19 patients received 2.0 mg/kg of propofol intravenously, followed by sevoflurane inhalation. Three patients who were anesthetized with sevoflurane were excluded from the analysis because they were omitted during the survey. We studied the patients who had PONV and RINVR scores 1, 6, and 24 hours post-operatively. RESULTS: The propofol group had a statistically lower incidence of PONV and lower RINVR scores in the following subclasses within 1 hour of surgery: symptom occurrence; symptom distress; and symptom experience. CONCLUSIONS: Propofol at induction and during maintenance of anesthesia can be used to prevent PONV within 1 hour post-operatively in patients undergoing gynecologic laparoscopic surgery.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Incidence , Inhalation , Laparoscopy , Methyl Ethers , Nausea , Postoperative Nausea and Vomiting , Propofol , Prospective Studies , VomitingABSTRACT
Background: Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.
Subject(s)
Adult , Benzimidazoles/administration & dosage , Benzimidazoles/therapeutic use , Cholecystectomy, Laparoscopic/adverse effects , Female , Humans , India , Ondansetron/administration & dosage , Ondansetron/therapeutic use , Postoperative Nausea and Vomiting/drug therapy , Serotonin 5-HT3 Receptor Antagonists/therapeutic useABSTRACT
The aim of the present study was to compare the antiemetic effect of intravenous Granisetron, Ondansetron & Metoclopramide in a randomized blinded study for prophylaxis of post operative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. 60 patients (ASA I & II) undergoing laparoscopic cholecystectomy under general anaesthesia were randomly allocated into three equal groups (n=20). Emetic episodes in first 24 hours were recorded and compared in different study groups. Results were analyzed. Minimal emetic episodes were observed in early post-operative period (1-12hrs) in patients who had received intravenous granisetron in comparison to ondansetron and metoclopramide. However, after 12 hours emesis free periods were statistically insignificant between group A and B while patients in group C had no antiemetic effect.
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BACKGROUND: Neuroaxial morphine may produce nausea and vomiting due to cephalad migration. Though it improves post- operative pain, it may have serious complication delaying recovery. The aim of this study was to investigate the efficacy of prophylactic antiemetics such as conventional metoclopramide or more expensive ondansetron. METHODS: Eighty-seven patients who underwent orthopedic knee arthroscopic surgery under epidural anesthesia were randomly assigned to three groups, which are (a) normal saline intravenous injection control group (Group C), (b) metoclopramide intravenous injection and intranasal spray study group (Group M), (c) ondansetron inravenous injection group (Group O). Before the end of surgery, all patients were given 3 mg of morphine and 2 mg of butorphanol mixture via epidural catheter for postoperative pain control. The anesthesia were all standardized. Post-operative nausea and vomiting were observed and used as outcome variables and postoperative pain, itching, somnolence, dizziness, urinary retention were also observed. RESULTS: The incidence of postoperative nausea was significantly lower in Group M (P = 0.0296) and Group O (P = 0.005) compared with Group C. The incidence of postoperative vomiting was significantly lower in Group O (P = 0.01) compared with Group C. But statistically no difference was noted in vomiting between Group C and Group M (P = 0.0579). CONCLUSIONS: The results suggest that ondansetron and metoclopramide are effective in reducing the incidence of post-operative nausea. But ondansetron is more effective in reducing the incidence of post-operative morphine induced vomiting.