Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465

Utilidad del ondansetrón vs dexametasona como profilaxis antiemética posoperatoria durante la cirugía mayor ginecológica / Usefulness of ondansetron versus dexamethasone as postoperative antiemetic prophylaxis during major gynecologic surgery

Introducción: Las náuseas y vómitos posoperatorios son una secuela no deseada durante la etapa de recuperación anestésica. Objetivo: Evaluar la utilidad de la dexametasona en comparación con el ondansetrón para la prevención de las náuseas y vómitos posoperatorios después de procedimientos quirúrgicos ginecológicos mayores, bajo anestesia general orotraqueal. Método: Se realizó un estudio observacional analítico, prospectivo, en 84 pacientes mayores de 19 años, en el Hospital Clínico Quirúrgico Miguel Enríquez desde octubre de 2018 hasta septiembre de 2019, divididas de forma secuencial, en orden de llegada a la unidad quirúrgica, en dos grupos. Al grupo 1 se le administró dexametasona (4 mg endovenosa); al grupo 2 (4 mg de ondansetrón), 30 min antes de finalizar la cirugía. Resultados: Predominó de forma significativa el riesgo medio de náuseas y vómitos posoperatorios en los pacientes con edades comprendidas entre 41 y 50 años. Predominó la condición de excelente y buena (pgt;0,05) en cuanto a la efectividad del tratamiento profiláctico. La cefalea prevaleció de forma significativa en el grupo 2. La mayor parte de las pacientes no presentó eventos adversos. Conclusiones: El ondansetrón y la dexametasona son útiles para la profilaxis de las náuseas y vómitos posoperatorios en pacientes intervenidas de cirugía mayor ginecológica, bajo anestesia general orotraqueal por lo que se considera un tratamiento seguro, con eventos adversos leves y de fácil control(AU)

Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (pgt;0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control(AU)

Incidence of nausea and vomiting after fast-track anaesthesia for heart surgery

Abstract Objective: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. Methods: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. Results: Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. Conclusion: PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.

Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery / Bloqueio paravertebral no controle da dor aguda pós-operatória e dor neuropática do nervo intercostobraquial em cirurgia mamária de grande porte

Abstract Background: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. Objectives: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24 h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. Methods: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine + adrenaline 3 µg mL−1 with a volume of 0.3 mL kg−1 preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24 h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0 h, 1 h, 6 h and 24 h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. Results: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24 h of study 0 h 1.90 (±2.59) versus 0.88 (±1.5) 1 h 2.23 (±2.2) versus 1.53 (±1.8) 6 h 1.15 (±1.3) versus 0.35 (±0.8); 24 h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0 h and 6 h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0 h 2.95 (±3.1) versus 1.55 (±2.1); 1 h 3.90 (±2.7) versus 2.43 (±1.9) 6 h 2.75 (±2.2) versus 1.68 (±1.5); 24 h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38 ± 0.81 µg kg−1 versus 3.51 ± 0.81 µg kg−1) and morphine (3.5 mg ± 3.4 versus 7 mg ± 6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. Conclusions: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

Resumo Justificativa: Estão descritas várias técnicas locorregionais para a abordagem da dor aguda e dor crônica após cirurgia de mama. O ideal seria uma técnica fácil de fazer, reprodutível, com pouco desconforto para as doentes, com poucas complicações e que permitirá um bom controle da dor aguda e uma diminuição da incidência de dor crônica, notadamente dor neuropática do intercostobraquial, por ser a entidade mais frequente. Objetivos: Estudar a aplicação de bloqueio paravertebral com picada única no pré-operatório de cirurgia mamária de grande porte. Avaliar numa primeira fase o controle de dor aguda e náuseas-vômitos no pós-operatório (NVPO) nas primeiras 24 horas e numa segunda fase a incidência de dor neuropática na região do nervo intercostobraquial seis meses após a cirurgia. Métodos: Foram incluídas 80 doentes do sexo feminino, ASA I-II, entre 18 e 70 anos, submetidas a cirurgia mamária de grande porte sob anestesia geral, estratificadas em dois grupos: anestesia geral (anestesia geral inalatória com opioides segundo resposta hemodinâmica) e paravertebral (bloqueio paravertebral com picada única em T4 com ropivacaína 0,5% + adrenalina 3 µg/mL com um volume de 0,3 mL/kg pré-operatoriamente e posterior indução e manutenção com anestesia geral inalatória). No pós-operatório imediato foi colocada PCA (Patient-controlled analgesia) de morfina programada com bolus a demanda durante 24 horas. Foram registados fentanil intraoperatório, consumo de morfina pós-operatória, complicações relacionadas com as técnicas, dor em repouso e ao movimento a 0, 1 h, 6 h e 24 h, assim como os episódios de NVPO. Foram analisadas todas as variáveis identificadas como fatores de cronificação da dor idade, tipo de cirurgia, ansiedade segundo escala de HADS (Hospital Anxiety and Depression scale), dor pré-operatória; acompanhamento no domicílio; índice de massa corporal (IMC), tratamentos adjuvantes de quimioterapia/radioterapia e foi verificada a homogeneidade das amostras. Aos seis meses da cirurgia foi avaliada, segundo escala DN4, a incidência de dor neuropática na área do nervo intercostobraquial. Resultados: O grupo paravertebral teve valores de VAS (Escala Visual Analógica) em repouso mais baixos ao longo das 24 horas de estudo 0 h 1,90 (± 2,59) versus 0,88 (± 1,5); 1 h 2,23 (± 2,2) versus 1,53 (± 1,8); 6 h 1,15 (± 1,3) versus 0,35 (± 0,8); 24 h 0,55 (± 0,9) versus 0,25 (± 0,8) com significado estatístico às 0 e às 6 horas. Em relação ao movimento o grupo paravertebral teve valores de VAS mais baixos e com significância estatística nos quatro momentos de avaliação: 0 h 2,95 (± 3,1) versus 1,55 (± 2,1); 1 h 3,90 (± 2,7) versus 2,43 (± 1,9) 6 h 2,75 (± 2,2) versus 1,68 (± 1,5); 24 h 2,43 (± 2,4) versus 1,00 (± 1,4). O grupo paravertebral consumiu menos fentanil (2,38 ± 0,81 µg/Kg versus 3,51 ± 0,81 µg/Kg) e menos morfina no pós-operatório (3,5 mg ± 3,4 versus 7 mg ± 6,4), com diferença estatisticamente significativa. Na avaliação de dor crônica aos seis meses no grupo paravertebral houve menos casos de dor neuropática na região do nervo intercostobraquial (três versus sete) embora sem significância estatística. Conclusões: O bloqueio paravertebral com picada única permite um adequado controle da dor aguda com menor consumo de opioides intraopreatórios e pós-operatórios, mas aparentemente não consegue evitar a cronificação da dor. Mais estudos são necessários para esclarecer o papel do bloqueio paravertebral na cronificação da dor em cirurgia mamária de grande porte.

Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery / Efeitos de um novo método de anestesia combinando propofol e anestesia volátil sobre a incidência de náusea e vômito no pós-operatório em pacientes submetidas à laparoscopia ginecológica

BACKGROUND: We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery. METHODS: Patients were randomly divided into three groups: those maintained with sevoflurane (Group S, n = 42), propofol (Group P, n = 42), or combined propofol and sevoflurane (Group PS, n = 42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery. RESULTS: The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2 h (74%, 76% and 43%, respectively, p = 0.001) and 0-24 h (71%, 76% and 38%, respectively, p < 0.0005). The incidence of nausea at 0-2 h (Group S = 57%, Group P = 26% and Group PS = 21%, p = 0.001) and 0-24 h (Group S = 62%, Group P = 29% and Group PS = 21%, p < 0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24 h. CONCLUSION: Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia "combined intravenous-volatile anesthesia (CIVA)".

JUSTIFICATIVA: Investigamos os efeitos de um novo método de anestesia, que combina propofol e anestesia volátil, sobre a incidência de náusea e vômito no período pós-operatório de pacientes submetidas à laparoscopia ginecológica. MÉTODOS: As pacientes foram randomicamente divididas em três grupos: manutenção com sevoflurano (Grupo S, n = 42), com propofol (Grupo P, n = 42) ou com a combinação de propofol e sevoflurano (Grupo PS, n = 42). Avaliamos as respostas completas (sem náusea e vômito no pós-operatório e sem uso de antiemético de resgate), incidência de náusea e vômito, escore de gravidade da náusea, frequência de vômitos, uso de antiemético de resgate e dor no pós-operatório em duas e 24 horas após a cirurgia. RESULTADOS: O número de doentes que apresentou uma resposta completa foi maior nos grupos P e PS do que no Grupo S em 0-duas horas (74%, 76% e 43%m respectivamente, p = 0,001) e 0-24 horas (71%, 76% e 38%, respectivamente, p < 0,0005). A incidência de náusea em 0-duas horas (Grupo S = 57%, Grupo P = 26% e Grupo PS = 21%, p = 0,001) e 0-24 horas (Grupo S = 62%; Grupo P = 29% e grupo PS = 21%, p < 0,0005) também foi significativamente diferente entre os grupos. Porém, não houve diferença significativa entre os grupos em relação à incidência ou frequência de vômitos ou uso de antiemético de resgate em 0-24 horas. CONCLUSÃO: A combinação de propofol e anestesia volátil durante a laparoscopia ginecológica efetivamente diminui a incidência de náusea no pós-operatório.

Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. A double blind placebo-controlled randomized clinical trial. Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P

PONV in ambulatory surgery: a comparison between ramosetron and ondansetron: a prospective, double-blinded, and randomized controlled study

Postoperative nausea and vomiting [PONV] frequently hampers implementation of ambulatory surgery in spite of so many antiemetic drugs and regimens. the study was carried out to compare the efficacy of Ramosetron and Ondansetron in preventing PONV after ambulatory surgery. It was a prospective, double blinded, and randomized controlled study. 124 adult patients of either sex, aged 25-55, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A [[n=62] receiving [IV] Ondansetron [4 mg]] and Group B [[n=62] receiving IV Ramosetron [0.3 mg]] prior to the induction of general anesthesia in a double-blind manner. Episodes of PONV were noted at 0.5, 1, 2, 4 h, 6, 12, and 18 h postoperatively. Statistically significant difference between Groups A and B [P <0.05] was found showing that Ramosetron was superior to Ondansetron as antiemetic both regarding frequency and severity. it was evident that preoperative prophylactic administration of single dose IV Ramosetron [0.3 mg] has better efficacy than single dose IV Ondansetron [4 mg] in reducing the episodes of PONV over 18 h postoperatively in patients undergoing day-care surgery under general anesthesia

[Effect of metoclopramide and ondansetrone plus dexamethason on postoperative nausea and vomiting in cholecystectomy laparoscopic surgery]

Nausea and vomiting are common complications after surgery which creates spasm, hypoxia and pulmonary aspiration. This study was done to determine the effect of ondansetrone, metoclopramide associated with dexamethasone on postoperative nausea and vomiting in cholecystectomy surgery using Laparoscopic method. In this double blind clinical trial study, 100 patients with ASA class I and II undergoing laparoscopic cholecystectomy divided randomly into two groups. The patients in the first group were received metoclopramide [10mg/kg/bw] with dexamethasone [8mg/kg/bw] and the second group were received ondansetron [4mg/kg/bw] with dexamethasone [8mg/kg/bw] intravenously 5 min before the final stage of surgery. Premedication and induction of anesthesia in patients were equal 5 minutes to 4 hours after surgery, postoperative nausea and vomiting were recorded for each patient. The rate of nausea in the first and the second groups were recorded 38% and 28%, respectively. The rate of vomiting in the first and the second groups were recorded 30% and 16%, respectively. These values were not significant. Ondansetron with dexamethasone non significantly reduced postoperative nausea and vomiting after laparoscopic cholecystectomy in comparison with metoclopramide with dexamethasone

A associação de haloperidol, dexametasona e ondansetrona reduz a intensidade de náusea, dor e consumo de morfina após gastrectomia vertical laparoscópica / Combination of haloperidol, dexamethasone, and ondansetron reduces nausea and pain intensity and morphine consumption after laparoscopic sleeve gastrectomy / La asociación de haloperidol, dexametasona y ondansetrón reduce la intensidad de náusea, dolor y consumo de morfi na después de la gastrectomía vertical laparoscópica

JUSTIFICATIVA E OBJETIVOS: Náusea e vômito pós-operatório (NVPO) ocorrem frequentemente após cirurgia bariátrica laparoscópica. A associação de haloperidol, dexametasona e ondansetrona pode reduzir esses eventos indesejáveis. O objetivo deste estudo foi avaliar a intensidade de náusea e dor, o número de episódios de vômito e o consumo de morfina no pós-operatório (PO) de pacientes obesos submetidos à gastrectomia vertical laparoscópica (GVL). MÉTODO: Estudo clínico, aleatorizado, controlado e duplamente encoberto feito em 90 pacientes com índice de massa corporal > 35 kg.cm-2. Os pacientes foram distribuídos em três grupos de 30 para receberem no Grupo O: ondansetron 8 mg; no Grupo DO: ondansetron 8 mg e dexametasona 8 mg e no Grupo HDO: ondansetron 8 mg, dexametasona 8 mg e haloperidol 2 mg. Foram avaliados a intensidade de náusea e dor, por meio de escala numérica verbal, o número cumulativo de episódios de vômito e o consumo de morfina no período de 0-2, 2-12, 12-24 e 24-36 horas de PO. RESULTADOS: A intensidade de náusea foi menor no Grupo HDO comparado com o Grupo O (p = 0,001), a intensidade da dor foi menor no Grupo HDO comparado com o Grupo O (p = 0,046) e o consumo de morfina no Grupo HDO foi menor do que no Grupo O (p = 0,037). Não houve diferença do número de episódios de vômito entre os grupos (p = 0,052). CONCLUSÃO: A associação de haloperidol, dexametasona e ondansetron promoveu redução da intensidade de náusea, da dor e do consumo de morfina no PO de pacientes obesos submetidos à GVL.

BACKGROUND AND OBJECTIVE: Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). METHOD: A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index > 35 kg.cm-2. Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2 mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. RESULTS: Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). CONCLUSION: The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

JUSTIFICATIVA Y OBJETIVOS: La náusea y el vómito postoperatorio (NVPO) ocurren a menudo después de la cirugía bariátrica laparoscópica. La asociación de haloperidol, dexametasona y ondansetrón puede reducir esos eventos no deseados. El objetivo de este estudio fue evaluar la intensidad de náusea y dolor, el número de episodios de vómito y el consumo de morfina en el postoperatorio (PO) de pacientes obesos sometidos a la gastrectomía vertical laparoscópica (GVL). MÉTODO: Estudio clínico, aleatorizado, controlado y doble ciego realizado en 90 pacientes con índice de masa corporal > 35 Kg/m2. Los pacientes se distribuyeron en tres grupos de 30 para recibir en el Grupo O: ondansetrón 8 mg; en el Grupo DO: ondansetrón 8 mg y dexametasona 8 mg y en el Grupo HDO: ondansetrón 8 mg, dexametasona 8 mg y haloperidol 2 mg. Fueron evaluados la intensidad de náusea y dolor por medio de la escala numérica verbal, el número acumulativo de episodios de vómito y el consumo de morfina en el período de 0-2, 2-12, 12-24 y 24-36 horas de PO. RESULTADOS: La intensidad de náusea fue menor en el Grupo HDO comparado con el Grupo O (p = 0,001), la intensidad del dolor fue menor en el Grupo HDO comparado con el Grupo O (p = 0,046) y el consumo de morfina en el Grupo HDO fue menor que en el Grupo O (p = 0,037). No hubo diferencia en el número de episodios de vómito entre los grupos (p = 0,052). CONCLUSIONES: La asociación de haloperidol, dexametasona y ondansetrón generó una reducción en la intensidad de la náusea, del dolor y del consumo de morfi na en el PO de pacientes obesos sometidos a la GVL.

Risk Assessment of Postoperative Nausea and Vomiting in the Intravenous Patient-Controlled Analgesia Environment: Predictive Values of the Apfel's Simplified Risk Score for Identification of High-Risk Patients

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS: We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS: In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION: Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.

Combination Effects of Capsicum Plaster at the Korean Hand Acupuncture Points K-D2 with Prophylactic Antiemetic on Postoperative Nausea and Vomiting after Gynecologic Laparoscopy

PURPOSE: This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV). METHODS: An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy. RESULTS: The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery. CONCLUSION: Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.

Prevención y tratamiento de náuseas y vómitos postoperatorios / Prevention and treatment of postoperative nausea and vomiting

Las náuseas y vómitos postoperatorios son complicaciones habituales de la anestesia y la cirugía en la práctica diaria, por lo que todo cirujano debe ser capaz de reconocerlas y enfrentarlas como tal. Sin embargo, la prevención y manejo de éstos no siempre es el adecuado, lo cual repercute en el confort de los pacientes. Descartando que esta complicación sea secundaria a la intervención quirúrgica, es necesario tener conocimiento respecto al arsenal farmacológico disponible en nuestro medio que nos permita un postoperatorio mejor tolerado. El objetivo de este trabajo es dar a conocer la evidencia actual respecto al óptimo manejo de estas complicaciones.

The postoperative nausea and vomiting are common complications of anesthesia and surgery in daily practice, so that every surgeon should be proficient to recognize and treat them as such. However, their prevention and management is not always adequate, which affects the comfort of patients. Discarding this complication secondary to surgical intervention, is necessary to have knowledge about the pharmacological arsenal available in our environment that allows us a better tolerated postoperatively. The aim of this paper is to present the current evidence regarding the optimal management of these complications.

Caracterización del uso de antieméticos en el postoperatorio en pacientes adultos sometidos a cirugía durante el periodo enero-mayo 2009, en el Hospital Clínica Bíblica de Costa Rica / Characterization of the use of antiemetics in the postoperative period in adult patients undergoing surgery during january to may 2009 in a private hospital Clínica Bíblica in Costa Rica

Evaluar y caracterizar el abordaje farmacoterapéutico antiemético en el periodo postoperatorio en pacientes adultos sometidos a cirugía en el Hospital Clínica Bíblica, hospital privado en Costa Rica. Métodos: Se seleccionaron pacientes, con edades entre 18 y 75 años, sometidos a cirugía, en quienes se había utilizado algún antiemético profiláctico al proceso quirúrgico, excluyéndose los pacientes que permanecieran hospitalizados menos de 24 horas tras la cirugía. Resultados: Dentro de la terapia profiláctica antiemética utilizada en este Hospital, se incluyó: granisetrón, metoclopramida, dexametasona, dimenhidrinato, entre otros; el granisetrón fue el antiemético más utilizado en un 81 por ciento de los casos, solo o en combinación. El uso de la dexametasona junto con el granisetrón fue la combinación más utilizada en un 57 por ciento. Sin hacer asociación al procedimiento quirúrgico, las náuseas y vómitos postoperatorios se presentaron en un 12 por ciento con el granisetrón, en un 25 por ciento con la metoclopramida, en un 9 por ciento con el dimenhidrinato, en un 13 por ciento con la dexametasona y en un 14 por ciento con otros antieméticos. Las cirugías que presentaron más incidencia de NVPO fueron las cirugías ortopédicas en un 30 por ciento, y las cirugías laparoscópicas en un 28 por ciento. En los casos en los que se utilizó fentanyl como anestésico, se presentaron vómitos en un 18 por ciento de los pacientes, mientras que en los casos en que no se utilizó fentanyl, el porcentaje de NVPO fue del 9 por ciento. Conclusión: A pesar del amplio uso de antieméticos profilácticamente, las náuseas y vómitos postoperatorios siguen presentándose en los pacientes de este Hospital. No se ha encontrado un algoritmo que permita prevenir totalmente las náuseas y vómitos postoperatorios, a pesar de la gran cantidad de conocimientos adquiridos en este campo. Se debe tomar en cuenta el riesgo individual de cada paciente y la satisfacción de este...

To evaluate and characterize the pharmaco-therapeutic approach with antiemetics during the postoperative, in adult patients undergoing surgery at a private hospital in Costa Rica(Hospital Clinica Biblica) Methods: This is an observational, prospective and cohort study. Those patients who had surgery and received antiemetic prophylaxis before the procedure were selected (ages between 18 and 75 years) excluding those who had hospitalization shorter than 24 hours.Results: Prophylactic antiemetic therapy in this private hospital utilizes granisetron, metoclopramide, dexamethasone, and dimenhydrinate, Granisetron, either alone or incombination, was the most used antiemetic in 81%. The combination most commonly used was dexamethasone and granisetron (57%). Without considering the surgical procedure, the incidence of postoperative nausea and vomiting (PONV) was 12% in patients taking granisetron, 25% with metoclopramide, 9% with dimenhydrinate, 13% with dexamethasone and 14% with otherantiemetics. On the other hand, looking at the procedure, the incidence of PONV in patients undergoing orthopedic surgery was by 30%, and 28% in those after laparoscopic surgery Finally,in cases in which fentanyl was used as an anesthetic 18% of the patients presented PONV, whereas in patients cases were fentanyl was not used, the rate of was 9%. Conclusion: Despite the widespread use of prophylactic antiemetics, PONV is still seen in thepatients at this private hospital. In spite of the wealth of knowledge in this field, physicians have not yet found an algorithm capable of the total prevention of PONV. Individual risks and patient`s satisfaction should be taken into account. Further research on this matter must continue in orderto unify and improve criteria of PONV treatment.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy.

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.

Effect of Ondansetron combined with Dexamethasone on Postoperative Nausea & Vomiting and Pain of Patients with Laparoscopic Hysterectomy

PURPOSE: The purpose of this study was to compare the effects of ondansetron combined with dexamethasone on Post-Operative Nausea and Vomiting (PONV) and pain with ondansetron alone in patients with laparoscopy assisted vaginal hysterectomy under general anesthesia. METHODS: Data were collected from April 1 through September 30, 2005 using a double blind method. Ondansetron 4 mg and dexamethasone 10 mg were administered to the experimental group (25 patients), and ondansetron 4 mg only to the control group (25 patients). The medications were administered through an intravenous line at the beginning peritoneum suture. PONV by Index of Nausea Vomiting and Retching (INVR), nausea by Visual Analogue Scale (VAS), and pain (VAS) were assessed at postoperative 1 hr, 3 hr, 6 hr, 24 hr, and 48 hr. Data were analyzed using repeated measures ANOVA, and Bonferroni methods. RESULTS: The experimental group that received ondansetron combined with dexamethasone had less PONV (p=.048), and nausea (p=.012) than control group that received ondansetron alone. However, there was no difference in pain (p=.557) between the patients in the two groups. CONCLUSION: We conclude that the administration of ondansetron combined with dexamethasone is more effective than the administration of ondansetron alone to reduce PONV in patients with laparoscopic hysterectomy.

Management of the patient at high risk for postoperative nausea and vomiting

Postoperative nausea and vomiting continue to be problematic areas in anesthesia as evidenced by frequent reports of therapies in the literature. No single therapy has been proven curative for all cases, in part because of the several emetic centers, all of which may be blocked by different classes of drugs and the diverse risk factors which act alone or in combination to cause vomiting. Identification of the patient most at risk allows for cost effective prophylactic management. An appropriate anesthetic technique can be planned that, relying on evidence based medicine, will decrease if not prevent the incidence of this most troubling complication

Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery- granisetron alone vs granisetron combined with dexamethasone / droperidol

Laparoscopic bariatric surgeries are associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of granisetron either alone or in combination with droperidol or dexamethasone, for the prevention of post operative nausea and vomiting [PONV] in patients undergoing laparoscopic bariatric surgeries. In a randomized, double-blind, placebo-controlled trial, 120 patients received either Granisetron 1 mg, Granisetron 1 mg plus Droperidol 1.25 mg, Granisetron 1 mg plus Dexamethasone 8 mg or Placebo [saline], intravenously immediately before induction of anesthesia. Perioperative anesthetic care was standardized in all patients. Patients were then observed for 24 hours after administration of the study drugs. The incidence of PONV was 30% with granisetron alone, 30% with granisetron plus droperidol, 20%, with granisetron plus dexamethanone, and 67% with placebo [P < 0.05; overall Fisher's exactprobability test]. The incidence of adverse events was not different among the 4 groups. Graniserton is effective and safe drug for reducing the incidence of PONV in patients undergoing bariatric surgeries, and becomes highly effective when combined with dexamethasone

Eficacia de la dexametasona en el tratamiento agudo de náuseas y vómitos posoperatorios: Comparación con droperidol y ondansetrón / Controlled trial of dexamethasone compared with droperidol and ondansetron for the treatment of postoperative nausea and vomiting

Background: Dexamethasone is useful as prophylaxis for postoperative nausea and vomiting (PONV). Aim: To study the short term efficacy of dexamethasone to treat PONV in adults without prophylaxis, and compare its efficacy with that of droperidol and ondansetron. Material and methods: A prospective study was performed with 120 consecutive adult patients presenting PONV in the postanesthesia care unit (PACU) at a University teaching hospital. During the occurrence of PONV, patients were randomized to receive in a double blind manner dexamethasone 8 mg IV (Group 1, n=40), droperidol 1.25 mg IV (Group 2, n=40), or ondansetron 2 mg IV (Group 3, n=40). Risk factors for PONV were recorded. Evaluations were made until discharge from the PACU and included presence of PONV, degree of sedation, and other potential adverse effects of the study drugs. Short term efficacy was defined as the percentage of patients free of PONV during all the stay in PACU after treatment. Results: General data was similar for the 3 groups. Mean ± SD stay in PACU after treatment was 101±34 minutes in Group 1, 93±33 minutes in Group 2, and 99±32 minutes in Group 3 (NS). Short term efficacy (CI 95%) was 55% (40-70%) in Group 1, 90% (81-99%) in Group 2, and 63% (48-78%) in Group 3 (p <0.05 for group 2 vs 1 and 3). There were no adverse effects attributable to the study drugs. Conclusions: Short term efficacy of dexamethasone to treat PONV was similar to ondansetron, but inferior to droperidol. Further studies are needed to define the duration of this effect of dexamethasone.

[ effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery]

Nausea and vomiting are common after general anesthesia. Nausea and vomiting are also common after tympanomastoid surgery that may endanger the results of middle ear reconstruction. Medications like dexamethasone have been used to prevent nausea and vomiting. In this study, the effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery has been evaluated. This study is a case control, double blinded, clinical trial that was performed in Dastgheib Hospital affiliated to the Shiraz University of Medical Sciences during 1381-1383. Eighty patients candidate for tympanomastoid surgery who were in physical status I [according to the classification of the American Anesthesiology Association] were selected randomly. These patients were divided into two control and study groups [each group consisting of 40 patients]. Just before induction of anesthesia, 2 ml normal saline was given intravenously to the patients in control group and 2 ml dexamethasone [8 mg] was given to the patients in the study group. The data were collected by a special form, and SPSS software and Chi Square test were used for statistical analysis. There was no significant difference between the study and control groups regarding the mean of age, male to female ratio, and length of anesthesia. Use of dexamethasone resulted in 32.5% decrease in post operative nausea [p=0.002] and 22.5% decrease in vomiting [p=0.04]. It seems that 8 mg intravenous dexamethasone is effective in reducing nausea and vomiting following tympanomastoid surgery and can be used routinely during tympanornastoid surgery