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Yan J, An R, Wang JJ, Wang M, Zhao Q, Zhao S, Xu J. Novel multimodal analgesic regimen for perioperative pain management after hepatic artery infusion chemotherapy in patients with advanced hepatocellular carcinoma. World J Gastrointest Surg 2025; 17:101439. [PMID: 40291897 PMCID: PMC12019060 DOI: 10.4240/wjgs.v17.i4.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/20/2025] [Accepted: 02/27/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Hepatic artery infusion chemotherapy (HAIC) is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma (HCC), exhibiting considerable efficacy. However, the prevalence of postoperative pain highlights the importance of pain management. Owing to the limitations inherent in existing pain management strategies, this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures. AIM To provide patients with a more comprehensive and effective pain management strategy. METHODS A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group (n = 50) and a multimodal group (n = 50). Baseline characteristics and perioperative data were collected. Upon enrollment, patients in the multimodal group received parecoxib (40 mg) 30 minutes before HAIC, followed by 48 hours of patient-controlled analgesia with sufentanil. In contrast, the control group underwent standard preoperative preparation (psychological support) and received dezocine (5 mg) intraoperatively, with intravenous flurbiprofen (100 mg) administered every 12 hours for 48 hours postoperatively. RESULTS Compared to the control group, the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0, 2, 4, 6, and 12 hours (P < 0.05). Furthermore, the multimodal group experienced a reduced incidence of postoperative nausea and vomiting, as well as a lower overall frequency of adverse events, compared to the control group (P < 0.05). Patient satisfaction was also significantly higher in the multimodal group than in the control group (P < 0.05). CONCLUSION Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain, minimizing adverse reactions, and improving patient satisfaction in HCC patients undergoing HAIC. This approach provides valuable clinical strategies for optimizing pain management in this patient population.
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Affiliation(s)
- Jing Yan
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Rui An
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Jing-Jing Wang
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Min Wang
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Qi Zhao
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Shen Zhao
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Jian Xu
- Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
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Belhassane M, Jaubert L. Comparison of Propofol and Sevoflurane as Anesthesia Maintenance Agents in Relation to Postoperative Pain, Nausea and Vomiting During Endoscopic Retrograde Cholangio-Pancreatography: A Prospective, Single-Center, Randomized, Single-Blind Pilot Study. Cureus 2025; 17:e81627. [PMID: 40322430 PMCID: PMC12048202 DOI: 10.7759/cureus.81627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2025] [Indexed: 05/08/2025] Open
Abstract
Introduction Halogen gas anesthesia is considered to be more conducive to postoperative nausea and vomiting (PONV) than total intravenous anesthesia. This difference has been demonstrated in surgery, but there have been no studies on postoperative pain (POP), nausea and vomiting based on anesthesia in the specific environment of endoscopy, to the best of our knowledge. Our aim was therefore to carry out a preliminary study to investigate a trend in POP, nausea and vomiting during endoscopic retrograde cholangio-pancreatography (ERCP), depending on the type of the maintenance anesthetic agent used. Methods This single-center, prospective, randomized, single-blind pilot study included 42 adult patients (American Society of Anesthesiologists classification score, ASA ≤ 3) benefiting from ERCP. They were randomized into two groups depending on the type of maintenance anesthetic used: the "sevoflurane" group and the "propofol" group (target-controlled infusion, Schnider model). Moreover, in both groups, all patients received balanced anesthesia based on alfentanil and rocuronium. The principal aim of our study was to investigate pain, nausea and vomiting during the first 48 hours postoperatively based on the anesthesia maintenance agent chosen. During the first 48 hours, PONV episodes were counted, pain was measured using the visual analogue scale and all analgesics and antiemetics administered were recorded. Results The two groups studied showed no statistically significant difference. The incidence of PONV was 36.4% in the sevoflurane group and 30% in the propofol group. Statistical analysis showed no significant difference in the occurrence of PONV or in the number of emetic episodes at 48 h postoperatively. There was no significant difference between the two groups in terms of the analgesics used to assess postoperative pain. Finally, there were no differences in the types of analgesics used postoperatively. Conclusion There appeared to be no difference in terms of postoperative pain, nausea and vomiting after ERCP in adults, based on the choice of maintenance anesthetic agent (sevoflurane versus propofol). However, the results of this pilot study should be confirmed in a larger sample.
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Affiliation(s)
- Mehdi Belhassane
- Anesthesiology and Reanimation, Université Libre de Bruxelles, Brussels, BEL
| | - Leo Jaubert
- Anesthetics, Hôpital Universitaire de Bruxelles (HUB) - Erasme Hospital, Brussels, BEL
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Kang HY. Comment on "Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a systematic review and meta-analysis". JOURNAL OF MINIMALLY INVASIVE SURGERY 2025; 28:9-10. [PMID: 40090371 PMCID: PMC11914832 DOI: 10.7602/jmis.2025.28.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 03/05/2025] [Indexed: 03/18/2025]
Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
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Zhou F, He H, Gao J, Zhang Z. Mining and analysis of dizziness adverse event signals in postoperative analgesia patients based on the FDA adverse event reporting system database. Front Pharmacol 2025; 16:1488469. [PMID: 40017599 PMCID: PMC11865249 DOI: 10.3389/fphar.2025.1488469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 01/23/2025] [Indexed: 03/01/2025] Open
Abstract
Objective This study aimed to explore the association between drugs used in postoperative anesthesia patients and postoperative dizziness using the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS) database, along with other risk factors for dizziness. Methods Using the FAERS database, we retrospectively analyzed dizziness cases reported between 2004 and the third quarter of 2023. We analyzed the relationship between drugs during postoperative anesthesia and the risk of postoperative dizziness, and conducted subgroup analysis according to age, sex and other factors. Signal detection was further performed using the reported odds ratio (ROR) method to identify medications significantly associated with an increased risk of postoperative dizziness. Results A total of 166,292 dizziness case reports were obtained, with 128 cases specifically related to postoperative analgesia. The number of dizziness reports has been increasing yearly, with a higher concentration of cases among individuals aged 18-85 years, predominantly in female patients. The analysis identified that amitriptyline, clonazepam, and ketamine were significantly associated with an increased risk of dizziness, with RORs of 34.91, 17.39, and 7.37, respectively. Subgroup analyses revealed variations in the relative risk of dizziness based on sex and age groups. Ketamine may be associated with higher risk of dizziness in the adult male subgroup. Conclusion The results of this study suggest that specific medications used by patients with postoperative analgesia are associated with an increased risk of postoperative dizziness. Future studies should further validate this finding and explore other potential risk factors.
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Affiliation(s)
- Fengqi Zhou
- Department of Anesthesiology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Haiou He
- Department of Anesthesiology, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei, China
| | - Jing Gao
- Department of Anesthesiology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Zhen Zhang
- Department of Anesthesiology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
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Shook JK, Hutson TE, Singer EA, Ghodoussipour SB. Optimizing Pharmacotherapy During Implementation of Enhanced Recovery After Surgery (ERAS) in Ambulatory Urologic Oncology Surgery: Narrative Review. Cancers (Basel) 2025; 17:614. [PMID: 40002209 PMCID: PMC11853187 DOI: 10.3390/cancers17040614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 01/26/2025] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
Adapting Enhanced Recovery After Surgery (ERAS) protocols to the ambulatory surgery setting is an ongoing need. While all surgical procedures necessitate the need for recovery protocols, urologists looking to perform outpatient surgical oncology procedures must be cognizant of the restrictive discharge criteria for an ambulatory procedure. Furthermore, a surgery being performed in the ambulatory setting should not imply that the procedure is without the risk of morbidity. With this in mind, ERAS protocols are paramount to ensuring optimal surgical outcomes. The individual components of such protocols encompass the perioperative period in its entirety. They include patient education, the stabilization of chronic medical conditions, perioperative nutrition, frailty mitigation, and the management of various postoperative sequalae. This review paper evaluates and summarizes the essential role of pharmacotherapy in ERAS protocols for ambulatory urologic oncology surgery.
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Affiliation(s)
- Jaret K. Shook
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Thomas E. Hutson
- Division of Hematology and Medical Oncology, School of Medicine, Texas Tech University Health Science Center, Lubbock, TX 79430, USA;
| | - Eric A. Singer
- Division of Urologic Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA;
| | - Saum B. Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA;
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Baek SW, Noh JH, Lee D. Outcomes of Aromatherapy in Nausea and Vomiting After Total Knee Arthroplasty. J Perianesth Nurs 2025; 40:62-68. [PMID: 39066774 DOI: 10.1016/j.jopan.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The purpose of this study is to assess the effectiveness of aromatherapy for postoperative nausea and vomiting (PONV) after total knee arthroplasty (TKA) under spinal anesthesia. DESIGN Prospective randomized four-arm placebo-controlled trials METHODS: One hundred and twenty subjects were allocated to each of the four groups based on the application of aromatic oil in subjects manifesting PONV: group 1 (lavender), group 2 (lemon), group 3 (peppermint), and group 4 (normal saline placebo). Aromatherapy was administered to all subjects immediately after surgery. Antiemetics were provided to subjects with significant nausea or vomiting. The severity of nausea and vomiting in subjects post-TKA was evaluated using the Halpin nausea and vomiting scale (HNV). The HNV and the concentration of antiemetic drug use were evaluated. Subjects' satisfaction with treatment for PONV was evaluated at discharge. FINDINGS HNV scores did not differ significantly between groups immediately after surgery until the third postoperative day (P > .05). The amount of antiemetic drug used in group 3 was significantly lower among the groups (P = .030). The subject satisfaction scale did not differ significantly among groups (P = .837). CONCLUSIONS Aromatherapy using peppermint oil reduced the amount of antiemetics used to treat PONV after TKA under spinal anesthesia with comparable subject satisfaction. Lavender and lemon oils did not reduce the use of antiemetics after TKA.
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Affiliation(s)
- So Won Baek
- Nursing Department, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, South Korea.
| | - Dongyun Lee
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea
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Wang Y, Shi J, Wei Y, Wu J. PONV Management in Adult Patients: Evidence-based Summary. J Perianesth Nurs 2024; 39:1095-1103. [PMID: 38935008 DOI: 10.1016/j.jopan.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To summarize the evidence on perioperative nausea and vomiting management in adult patients worldwide. DESIGN This is a summary of the best evidence on postoperative nausea and vomiting in adults. METHODS Databases such as British Medical Journal Best Practice, Cochrane Library, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearing House, Guidelines International Network, American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN), Registered Nurses Association of Ontario, PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Yimaitong Clinical Guidelines, China Anesthesia Official website, SinoMed, China National Knowledge Infrastructure, Wanfang, and VIP were searched to collect the relevant guidelines for clinical decision-making, best practices, systematic review, evidence summary, and expert consensus about perioperative nausea and vomiting management. The retrieval time was from the establishment of the database to January 2022. Two authors independently evaluated the quality of the included literature and extracted and summarized the evidence that met the quality criteria. FINDINGS A total of 22 studies, including 1 best practice, 2 clinical decision-making articles, 7 evidence summaries, 1 clinical guideline, 9 systematic reviews, and 2 expert consensuses, were included. The summary of 37 pieces of evidence from 7 aspects: risk factors, assessment methods, multimodal prevention strategy, health education, nondrug intervention, drug prevention, postoperative analgesia management strategy, and organization management. CONCLUSIONS The health care team should select the best evidence according to the characteristics of the department and clinical practice, scientifically manage perioperative nausea and vomiting of patients, reduce the incidence and severity of nausea and vomiting, and promote the accelerated rehabilitation of patients.
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Affiliation(s)
- Yiting Wang
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
| | - Jiaqi Shi
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
| | - Yanjun Wei
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China.
| | - Jin Wu
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
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Sarkhosh M, Rajabi Visroodi E, Samaee H, Farhadi M, Moradimajd P. Effectiveness of Chamomile in Reducing the Incidence and Severity of Nausea and Vomiting After Middle Ear Surgery: A Triple-Blind Randomized Study. Anesth Pain Med 2024; 14:e153566. [PMID: 40092536 PMCID: PMC11910166 DOI: 10.5812/aapm-153566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 12/07/2024] [Accepted: 12/13/2024] [Indexed: 03/19/2025] Open
Abstract
Background Nausea and vomiting are among the most common complications after surgery. Objectives The aim of this study was to investigate the effectiveness of chamomile in reducing the incidence and severity of nausea and vomiting after middle ear surgery. Methods A total of 110 patients who met the inclusion criteria were randomly assigned to either the chamomile or placebo group. Group A consumed chamomile drops (500 mg), while group B consumed cornstarch with 30 mL of water, one hour before surgery. The severity of nausea and frequency of vomiting were recorded at recovery (time of zero), 1, 2, 4, and 6 hours after surgery using the Rhodes Index. Data were analyzed using SPSS v.21 software, paired t-tests, and chi-square tests. Results A total of 110 patients were included, with an average age of 36.14 ± 10.3 years (group A) and 34.28 ± 13.3 years (group B). There was no statistically significant difference between the chamomile and placebo groups in terms of the severity of nausea and the frequency of vomiting immediately after recovery (time of zero), 1, 2, and 6 hours after surgery (P > 0.05). However, 4 hours post-surgery, the severity of nausea in the chamomile group was lower than in the placebo group, and a statistically significant difference was observed between the two groups (P = 0.03). No gastrointestinal side effects were reported. Conclusions Based on the results of this study, chamomile can be used to reduce nausea and vomiting after middle ear surgery, given its availability and low cost.
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Affiliation(s)
- Maryam Sarkhosh
- Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Rajabi Visroodi
- Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamidreza Samaee
- Emam Sajjad Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Motahareh Farhadi
- Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Moradimajd
- Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran
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Lin H, Baker JW, Meister K, Lak KL, Martin Del Campo SE, Smith A, Needleman B, Nadzam G, Ying LD, Varban O, Reyes AM, Breckenbridge J, Tabone L, Gentles C, Echeverri C, Jones SB, Gould J, Vosburg W, Jones DB, Edwards M, Nimeri A, Kindel T, Petrick A. American society for metabolic and bariatric surgery: intra-operative care pathway for minimally invasive Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:895-909. [PMID: 39097472 DOI: 10.1016/j.soard.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB). OBJECTIVE This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU). METHODS PubMed queries were performed from January 2001 to December 2019 and reviewed according to Level of Evidence regarding specific key questions developed by the committee. RESULTS Evidence-based recommendations are made for care of patients undergoing RYGB including the pre-operative holding area, intra-operative management and performance of RYGB, and concurrent procedures. CONCLUSIONS This document may provide guidance based on recent evidence to bariatric surgeons and providers for the intra-operative care for minimally invasive RYGB.
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Affiliation(s)
- Henry Lin
- Department of Surgery, Signature Healthcare, Brockton, Massachusetts.
| | - John W Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Kathleen L Lak
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - April Smith
- Department of Pharmacy, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Geoffrey Nadzam
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Lee D Ying
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut
| | - Oliver Varban
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Angel Manuel Reyes
- Department of General Surgery, St. Michael Medical Center, Silverdale, Washington
| | - Jamie Breckenbridge
- Department of General Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Lawrence Tabone
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Charmaine Gentles
- Department of Surgery, Northshore University Hospital, Manhasset, New York
| | | | - Stephanie B Jones
- Department of Anesthesiology, Northwell Health, New Hyde Park, New York
| | - Jon Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wesley Vosburg
- Department of Surgery, Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Daniel B Jones
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tammy Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anthony Petrick
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Grillo R, Borba AM, Brozoski MA, da Silva YS, Samieirad S, Naclério-Homem MDG. Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis. Oral Maxillofac Surg 2024; 28:1019-1028. [PMID: 38509315 DOI: 10.1007/s10006-024-01235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. METHODS A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. RESULTS The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. CONCLUSIONS Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry, University of São Paulo, São Paulo, SP, Brazil.
- Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, DF, Brazil.
- Faculdade de Odontologia, University of São Paulo, Av. Prof. Lineu Prestes, 2227. Cidade Universitária, São Paulo, 05508-000, SP, Brazil.
| | | | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | | | - Sahand Samieirad
- Department of Oral & Maxillofacial surgery, Mashhad dental school, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Xu JH, Tan HL, Zhang LN, Zhou ZG, Yuan L, Kong LX, Song MQ, Qi LJ, Ji XY. Transcutaneous Electrical Acupoint Stimulation Combined with Moderate Sedation of Remimazolam Tosilate in Gastrointestinal Endoscopy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Ther 2024; 13:919-936. [PMID: 38890239 PMCID: PMC11254895 DOI: 10.1007/s40122-024-00618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Further clinical validation is required to determine whether transcutaneous electrical acupoint stimulation (TEAS) can replace opioids and be used in combination with remimazolam for sedation during gastrointestinal endoscopy. METHODS A total of 108 outpatients who underwent diagnostic gastrointestinal endoscopy were randomly divided into three groups: fentanyl plus remimazolam group (group C), TEAS plus remimazolam group (group E), and placebo-TEAS plus remimazolam group (group P). The assessments of patient satisfaction, physician satisfaction, and pain scale score during the examination constituted the primary endpoints of the study. The secondary endpoints were the time of recovery, recovery of normal behavioral function and discharge, incidence of adverse reactions, and dose of remimazolam. RESULTS Compared with group C, group E had a greater median score for patient satisfaction at follow-up and a slightly lower median score for physician satisfaction. The pain score of group E was slightly greater than that of group C, but the difference was not significant. However, in group C, the incidence of hypoxemia, the rate of nausea and the severity of vertigo were greater, and the number of patients discharged and resuming normal behavioral function was greater than those in the other two groups. The dose of remimazolam in group C and group E was less than that in group P. CONCLUSIONS TEAS combined with moderate sedation of remimazolam can provide an ideal sedative effect, which preferably suppresses discomfort caused by gastrointestinal endoscopy and has fewer sedation-related complications. TRIAL REGISTRATION ID: NCT05485064; First registration (29/07/2022); Last registration (02/11/2022) (Clinical Trials.gov).
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Affiliation(s)
- Jian-Han Xu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hai-Ling Tan
- Department of Pharmacy, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Li-Na Zhang
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, 266071, China.
| | - Zan-Gong Zhou
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Yuan
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling-Xin Kong
- Department of Rehabilitation Physiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ming-Quan Song
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Jie Qi
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiang-Yu Ji
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Liu J, Fang S, Cheng L, Wang L, Wang Y, Gao L, Liu Y. A web-based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery. J Obstet Gynaecol Res 2024; 50:1216-1228. [PMID: 38644529 DOI: 10.1111/jog.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE The aim of this study was to develop a web-based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery. METHODS The patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk-factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk-factors, and the variables with statistical significance were selected in multivariable logistic model building. The web-based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model. RESULTS Ultimately, a total of five predictors including patient-controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98-12.44), motion sickness (OR, 4.80; 95% CI, 2.71-8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41-7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44-3.43), and pain response (OR, 1.64; 95% CI, 1.48-1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC-areas under the curve, 93.0%; 95% CI, 90.7%-95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits. CONCLUSIONS This dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | | | - Lin Cheng
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Liwei Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuwen Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Lunan Gao
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
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Ha NY, Park MJ, Ko SJ, Park JW, Kim J. Effect of herbal medicine on postoperative nausea and vomiting after laparoscopic surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38334. [PMID: 38847692 PMCID: PMC11155545 DOI: 10.1097/md.0000000000038334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/02/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Traditionally, herbal medicines have been used to alleviate nausea and vomiting; however, a comprehensive clinical evaluation for postoperative nausea and vomiting (PONV), especially after laparoscopic surgery, remains limited. This review aimed to evaluate the efficacy and safety of herbal medicine as an alternative therapy to prevent and manage nausea and vomiting after laparoscopic surgery compared with untreated, placebo, and Western medicine groups. METHODS We searched 11 databases, including EMBASE, PubMed, and the Cochrane Library, to collect randomized controlled trials (RCTs) of herbal medicines on PONV after laparoscopic surgery on July 7, 2022. Two independent reviewers screened and selected eligible studies, extracted clinical data, and evaluated the quality of evidence using the Cochrane risk-of-bias tool. The primary outcome was the incidence of PONV, whereas the secondary outcomes included the frequency and intensity of PONV, symptom improvement time, antiemetic requirement frequency, and incidence of adverse events. Review Manager Version 5.3. was used for the meta-analysis. RESULTS We identified 19 RCTs with 2726 participants comparing herbal medicine with no treatment, placebo, and Western medicine. The findings showed that compared with no treatment, herbal medicine demonstrated significant effects on vomiting incidence (risk ratio [RR] = 0.43, 95% confidence interval [CI] 0.32-0.57, P < .00001). Compared with placebo, herbal medicine revealed a significant effect on the severity of nausea 12 hours after laparoscopic surgery (standardized mean difference = -2.04, 95% CI -3.67 to -0.41, P = .01). Herbal medicines showed similar effects with Western medicine on the incidence of postoperative nausea (RR = 0.94, 95% CI 0.63-1.42, P = .77) and vomiting (RR = 0.68, 95% CI 0.25-1.84, P = .45). Furthermore, comparing the experimental group containing herbal medicine and control group excluding herbal medicine, adverse events were considerably lower in the group with herbal medicine (RR = 0.45, 95% CI 0.27-0.72, P = .001). CONCLUSION Herbal medicine is an effective and safe treatment for nausea and vomiting secondary to laparoscopic surgery. However, the number of studies was small and their quality was not high; thus, more well-designed RCTs are warranted in the future.
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Affiliation(s)
- Na-Yeon Ha
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Mu-Jin Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seok-Jae Ko
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jinsung Kim
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Liao KL, Wang HH, Yang LY, Hsu YF, Chou FH, Chu YC. Effectiveness of Chewing Gum on Nausea and Vomiting Following Postprocedure: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2024; 39:417-424.e2. [PMID: 38206218 DOI: 10.1016/j.jopan.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of chewing gum in reducing postprocedure nausea and vomiting. DESIGN A systematic review and meta-analysis. METHODS A systematic literature search was performed on MEDLINE Complete, EMBASE, CINAHL, PubMed, Web of Science, Academic Search Complete, and Cochrane Library databases from their inception to October 2, 2022. Methodological quality was assessed using the revised Cochrane Risk of Bias 2.0 tool for randomized trials. A meta-analysis was performed using a fixed-effects model to calculate pooled effects with Review Manager 5.4.1. FINDINGS Twelve randomized trials encompassing 1,458 participants were pooled. The chewing gum intervention was effective in reducing vomiting (P = .007; risk ratio = 0.55; 95% Cl = 0.35-0.85), but not nausea (P = .14; risk ratio = 0.84; 95% Cl = 0.66-1.06). Thirty-minute sessions of gum chewing were significantly more effective in reducing vomiting than 15-minute sessions (P = .04; risk ratio = 0.31; 95% Cl = 0.1-0.93). CONCLUSIONS The results indicate that repeated gum chewing sessions of at least 30 minutes may act as a nonpharmacological intervention for reducing vomiting. However, further studies are necessary to determine the outcomes of chewing gum interventions.
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Affiliation(s)
- Kuei-Lin Liao
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Li-Yu Yang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Yi-Chin Chu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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15
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Wang Y, Guo J, Cheng Y. A commentary on 'transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: a meta-analysis of randomized controlled trials'. Int J Surg 2024; 110:3962-3963. [PMID: 38445481 PMCID: PMC11175713 DOI: 10.1097/js9.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Affiliation(s)
| | - Jianrong Guo
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, People’s Republic of China
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Zhang W, Shen Z, Jiang J, Zhu S, Zhang P, Chen S, Kang M. Comparative efficacy of prophylactic protocols in reducing perioperative nausea and vomiting during video-assisted thoracoscopic radical resection of lung cancer. Sci Rep 2024; 14:9818. [PMID: 38684769 PMCID: PMC11059372 DOI: 10.1038/s41598-024-59687-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/13/2024] [Indexed: 05/02/2024] Open
Abstract
Lung cancer, a global mortality leader, often necessitates Video-Assisted Thoracoscopic (VATS) surgery. However, post-operative nausea and vomiting (PONV) is common, highlighting a need for effective management and prevention strategies in this context. A retrospective case-control study at Fujian Medical University Union Hospital evaluated patients undergoing VATS radical resection of lung cancer between May and September 2022. Patients were categorized based on PONV prevention methods, and data encompassing demographics, surgical history, and postoperative adverse events s were analyzed to assess the association between prophylactic protocols and PONV incidence. The Netupitant and Palonosetron Hydrochloride (NEPA) group showed a significant reduction in PONV occurrences post-surgery compared to Ondansetron (ONDA) and Control groups, emphasizing NEPA's efficacy in alleviating PONV symptoms (P < 0.05). Furthermore, following VATS radical resection of lung cancer, NEPA markedly reduced the intensity of PONV symptoms in patients. Both univariate and multivariate logistic analyses corroborated that NEPA independently reduces PONV risk, with its protective effect also apparent in susceptible populations like females and non-smokers. NEPA utilization markedly reduced both the incidence and severity of PONV in patients undergoing VATS radical resection of lung cancer, serving as an independent protective factor in mitigating PONV risk post-surgery.
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Affiliation(s)
- Weiguang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhimin Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Junfei Jiang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Shujing Zhu
- The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Peipei Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Sui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
- Clinical Research Center for Thoracic Tumors of Fujian Province, Fuzhou, China.
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Komann M, Rabe Y, Lehmann T, Dreiling J, Weinmann C, Kranke P, Meißner W. Operation-specific risk of postoperative nausea: a cross-sectional study comparing 72 procedures. BMJ Open 2024; 14:e077508. [PMID: 38382957 PMCID: PMC10882331 DOI: 10.1136/bmjopen-2023-077508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Determination of the procedure-specific, risk-adjusted probability of nausea. DESIGN Cross-sectional analysis of clinical and patient-reported outcome data. We used a logistic regression model with type of operation, age, sex, preoperative opioids, antiemetic prophylaxis, regional anaesthesia, and perioperative opioids as predictors of postoperative nausea. SETTING Data from 152 German and Austrian hospitals collected in the Quality Improvement in Postoperative Pain Treatment (QUIPS) registry from 2013 to 2022. Participants completed a validated outcome questionnaire on the first postoperative day. Operations were categorised into groups of at least 100 cases. PARTICIPANTS We included 78 231 of the 293 947 participants from the QUIPS registry. They were 18 years or older, willing and able to participate and could be assigned to exactly one operation group. MAIN OUTCOME MEASURES Adjusted absolute risk of nausea on the first postoperative day for 72 types of operation. RESULTS The adjusted absolute risk of nausea ranged from 6.2% to 36.2% depending on the type of operation. The highest risks were found for laparoscopic bariatric operations (36.2%), open hysterectomy (30.4%), enterostoma relocation (29.8%), open radical prostatectomy (28.8%), laparoscopic colon resection (28.6%) and open sigmoidectomy (28%). In a logistic regression model, male sex (OR: 0.39, 95% CI 0.37 to 0.41, p<0.0001), perioperative nausea and vomiting prophylaxis (0.73, 0.7 to 0.76, p<0.0001), intraoperative regional anaesthesia (0.88, 0.83 to 0.93, p<0.0001) and preoperative opioids for chronic pain (0.74, 0.68 to 0.81, p<0.0001) reduced the risk of nausea. Perioperative opioid use increased the OR up to 2.38 (2.17 to 2.61, p<0.0001). CONCLUSIONS The risk of postoperative nausea varies considerably between surgical procedures. Patients undergoing certain types of operation should receive special attention and targeted prevention strategies. Adding these findings to known predictive tools may raise awareness of the still unacceptably high incidence of nausea in certain patient groups. This may help to further reduce the prevalence of nausea. TRIAL REGISTRATION NUMBER DRKS00006153; German Clinical Trials Register; https://drks.de/search/de/trial/DRKS00006153.
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Affiliation(s)
- Marcus Komann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Yvonne Rabe
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Johannes Dreiling
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University of Würzburg, Würzburg, Germany
| | - Winfried Meißner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Arslan HN, Çelik SŞ. Nonpharmacological Nursing Interventions in Postoperative Nausea and Vomiting: A Systematic Review. J Perianesth Nurs 2024; 39:142-154. [PMID: 37865902 DOI: 10.1016/j.jopan.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE This study aims to assess the impact of nonpharmacological nursing interventions on postoperative nausea and vomiting (PONV). DESIGN This is a systematic review. METHODS MEDLINE, Web of Science, ScienceDirect, Tübitak-ULAKBİM, and TRDizin databases were searched for the following search terms, including "Postoperative Nausea and Vomiting," "Nurse," "Nursing," and "Nonpharmacological Interventions" to identify nonpharmacological nursing interventions for PONV. A systematic review of English and Turkish articles published in the period between January 1, 2012 and June 1, 2023 was conducted. The PICOT-SD method was used to determine the compatibility of the pieces with the eligibility criteria. FINDINGS Fifty-eight of 3,874 articles obtained from databases fulfilled the eligibility criteria. This study demonstrated that acupuncture, aromatherapy, the oral intake of ginger, listening to music, education, and visits to patients decreased the incidence of nausea and vomiting and increased the quality of life. Additionally, it was found that patients' quality of life tended to improve along with reductions in postoperative complications. CONCLUSIONS The results of this study support previous findings in the literature and demonstrate that nonpharmacological nursing interventions help reduce and prevent PONV. Based on our results, we suggest that nonpharmacological nursing interventions can be employed for the management of PONV in patients undergoing surgery.
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Syed AN, Baghdadi S, Muhly WT, Baldwin KD. Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review. JBJS Rev 2024; 12:01874474-202401000-00006. [PMID: 38194592 DOI: 10.2106/jbjs.rvw.23.00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) affects patient satisfaction, health care costs, and hospital stay by complicating the postoperative recovery period after adolescent idiopathic scoliosis (AIS) spinal fusion surgery. Our goal was to identify recommendations for optimal management of PONV in AIS patients undergoing posterior spinal fusion (PSF). METHODS We performed a systematic review in June 2022, searching the PubMed and Embase electronic databases using search terms "(Adolescent idiopathic scoliosis) AND (Postoperative) AND (Nausea) AND (Vomiting)." Three authors reviewed the 402 abstracts identified from January 1991 to June 2022. Studies that included adolescents or young adults (<21 years) with AIS undergoing PSF were selected for full-text review by consensus. We identified 34 studies reporting on incidence of PONV. Only 6 studies examined PONV as the primary outcome, whereas remaining were reported PONV as a secondary outcome. Journal of Bone and Joint Surgery Grades of recommendation were assigned to potential interventions or clinical practice influencing incidence of PONV with respect to operative period (preoperative, intraoperative, and postoperative period) on the basis that potential guidelines/interventions for PONV can be targeted at those periods. RESULTS A total of 11 factors were graded, 5 of which were related to intervention and 6 were clinical practice-related. Eight factors could be classified into the operative period-1 in the intraoperative period and 7 in the postoperative period, whereas the remaining 3 recommendations had overlapping periods. The majority of grades of recommendations given were inconclusive or conflicting. The statement that neuraxial and postoperative systemic-only opioid therapy have a similar incidence of PONV was supported by good (Grade A) evidence. There was fair (Grade B) and poor evidence (Grade C) to avoid opioid antagonists and nonopioid local analgesia using wound catheters as PONV-reducing measures. CONCLUSION Although outcomes after spinal fusion for AIS have been studied extensively, the literature on PONV outcomes is scarce and incomplete. PONV is most commonly included as a secondary outcome in studies related to pain management. This study is the first to specifically identify evidence and recommendations for interventions or clinical practice that influence PONV in AIS patients undergoing PSF. Most interventions and clinical practices have conflicting or limited data to support them, whereas others have low-level evidence as to whether the intervention/clinical practice influences the incidence of PONV. We have identified the need for expanded research using PONV as a primary outcome in patients with AIS undergoing spinal fusion surgery.
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Affiliation(s)
- Akbar Nawaz Syed
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Soroush Baghdadi
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith D Baldwin
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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20
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Zhao C, Chen W, Wang D, Cong X, Zhu M, Zhu C, Xu J, Cai J. Ginger (Zingiber officinale Roscoe) preparations for prophylaxis of postoperative nausea and vomiting: A Bayesian network meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116791. [PMID: 37379959 DOI: 10.1016/j.jep.2023.116791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/20/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ginger has been proposed for prevention of postoperative nausea and vomiting (PONV), however it remains equivocal whether ginger can be an alternative option and which certain preparation is optimal for PONV prophylaxis. AIM OF THE STUDY We conducted a network meta-analysis (NMA) to compare and rank relative efficacy for PONV control among all available ginger preparations collected in the databases. METHODS Eligible records were identified by retrieving Medline (via Pubmed), Embase, Web of Science, CENTRAL, CNKI, WHO ICTRP and ClinicalTrials.gov for randomized controlled trials that investigated the efficacy of ginger therapies for the prophylaxis of PONV. A bayesian NMA within random-effects models was implemented. Certainty of evidence for estimates was investigated following GRADE framework. We prospectively registered the protocol (CRD 42021246073) in PROSPERO. RESULTS Eighteen publications comprising 2199 participants with PONV were identified. Ginger oil (RR [95%CI], 0.39 [0.16, 0.96]) appeared to have the highest probability of being ranked best to decrease the incidence of postoperative vomiting (POV), with statistical significance compared with placebo, based on high to moderate confidence in estimates. With regard to reducing postoperative nausea (PON), statistically superiority was not observed in ginger regimens compared with placebo based on moderate to low certainty of evidence. Reduction in antemetic use and nausea intensity were noticed in ginger powder and oil. Ginger was significantly associated with better efficacy for Asian, older age, higher dosage, preoperative administration, hepatobiliary and gastrointestinal surgery. CONCLUSIONS Ginger oil appeared to be superior to other ginger treatments for the prophylaxis of POV. With regard to reducing PON, ginger preparations indicated no obvious advantages.
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Affiliation(s)
- Chunyang Zhao
- School of Pharmacy, China Medical University, Shenyang, 110122, China; Department of Pharmacy, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| | - Weiyuan Chen
- Department of Pharmacy, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| | - Daqiu Wang
- Department of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, China.
| | - Xiufeng Cong
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Min Zhu
- School of Health Management, China Medical University, Shenyang, 110122, China.
| | - Chengrui Zhu
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| | - Jiayao Xu
- China Medical University-The Queen's University of Belfast Joint College, China Medical University, Shenyang, 110122, China.
| | - Jiayi Cai
- School of Pharmacy, China Medical University, Shenyang, 110122, China.
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Lee DJ, Douglas JE, Chang J, Wilensky J, Jackson C, Lee JYK, Grady MS, Yoshor D, Kohanski MA, Palmer JN, Atkins JH, Adappa ND. The use of aprepitant for the prevention of postoperative nausea and vomiting in endoscopic transsphenoidal pituitary surgery. Int Forum Allergy Rhinol 2023; 13:2180-2186. [PMID: 37302141 DOI: 10.1002/alr.23208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear. The purpose of this study was to evaluate the effect of aprepitant in reducing PONV in endoscopic transsphenoidal (TSA) pituitary surgery. METHODS A retrospective chart review between July 2021 and January 2023 of 127 consecutive patients who underwent TSA was performed at a tertiary academic institution. Patients were divided into 2 groups based on preoperative aprepitant use. Two groups were matched based on known risk factors of PONV (age, sex, nonsmoking, and history of PONV). The primary outcome was the incidence of PONV. Secondary outcome measures included the number of anti-emetic use, length of stay, and postoperative cererebrospinal fluid (CSF) leak. RESULTS After matching, 48 patients were included in each group. The aprepitant group demonstrated a significantly lower incidence of vomiting than the non-aprepitant group (2.1% vs 22.9%, p = 0.002). The number of nausea episodes and anti-emetic use decreased with aprepitant use (p < 0.05). There was no difference in the incidence of nausea, length of stay, or postoperative CSF leak. Multivariate analysis demonstrated that aprepitant decreased the incidence of postoperative vomiting with odds ratio of 0.107. CONCLUSION Aprepitant may serve as a useful preoperative treatment to reduce PONV in patients undergoing TSA. Further studies are needed to evaluate its impact in other arenas of endoscopic skull base surgery.
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Affiliation(s)
- Daniel J Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeremy Chang
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jadyn Wilensky
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Jackson
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y K Lee
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Sean Grady
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Yoshor
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua H Atkins
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Li F, Huang X, Liu W, Huang W, Cheng J, Yin D. Dexamethasone with aggressive warming facilitates pain reduction, reduced blood loss, and quicker recovery after total hip arthroplasty. Sci Rep 2023; 13:19582. [PMID: 37950063 PMCID: PMC10638361 DOI: 10.1038/s41598-023-47050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
This study aimed to evaluate the optimal frequency of dexamethasone (DEX) administration and the efficacy of DEX with aggressive warming in total hip arthroplasty (THA), which remains unclear. A total of 150 patients were treated with DEX (10 mg) once before and once or twice after surgery with or without intraoperative aggressive warming. On postoperative day 3, the dynamic visual analogue scale scores and C-reactive protein (CRP) and interleukin-6 (IL-6) levels in participants administered with DEX twice after surgery were significantly lower than those who did not receive the second dose. The range of motion (ROM), postoperative fatigue based on Identity-Consequence-Fatigue Scale, average temperature at different stages, intraoperative blood loss, and postoperative drainage volume in patients who were subjected to warming were significantly higher than those who were not. The degree of satisfaction was also higher in the patients who received both second dose and warming than those who received neither. No differences in complications were observed based on the treatments. An additional dose of DEX at 48 h post-surgery has short-term advantages in terms of analgesia, anti-inflammatory effects, and accelerated rehabilitation after THA. DEX combined with aggressive warming further optimises short-term ROM and fatigue and improves the degree of satisfaction.Clinical trial was registered in the International Clinical Trial Registry, and the date of registration is 2/12/2020 (ChiCTR2000040560).
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Affiliation(s)
- Fulin Li
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiao Huang
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wenhui Liu
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wenwen Huang
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jinwen Cheng
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Dong Yin
- Department of Joint and Sports Medicine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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Wang J, Shen Y, Guo W, Zhang W, Cui X, Cai S, Chen X. Propofol EC 50 for inducing loss of consciousness in patients under combined epidural-general anesthesia or general anesthesia alone: a randomized double-blind study. Front Med (Lausanne) 2023; 10:1194077. [PMID: 38020175 PMCID: PMC10661411 DOI: 10.3389/fmed.2023.1194077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Combined epidural-general anesthesia (GA + EA) has been recommended as a preferred technique for both thoracic and abdominal surgery. The epidural anesthesia on the general anesthetic (GA) requirements has not been well investigated. Therefore, we conducted the present study to explore the predicted effect-site concentration of propofol (Ceprop) required for achieving the loss of consciousness (LOC) in 50% of patients (EC50) with or without epidural anesthesia. Methods Sixty patients scheduled for gastrectomy were randomized into the GA + EA group or GA alone group to receive general anesthesia alone. Ropivacaine 0.375% was used for epidural anesthesia to achieve a sensory level of T4 or above prior to the induction of general anesthesia. The EC50 of predicted Ceprop for LOC was determined by the up-down sequential method. The consumption of anesthetics, emergence time from anesthesia, and postoperative outcomes were also recorded and compared. Results The EC50 of predicted Ceprop for LOC was lower in the GA + EA group than in the GA alone group [2.97 (95% CI: 2.63-3.31) vs. 3.36 (95% CI: 3.19-3.53) μg mL-1, (p = 0.036)]. The consumption of anesthetics was lower in the GA + EA group than in the GA alone group (propofol: 0.11 ± 0.02 vs. 0.13 ± 0.02 mg kg-1 min-1, p = 0.014; remifentanil: 0.08 ± 0.03 vs. 0.14 ± 0.04 μg kg-1 min-1, p < 0.001). The emergence time was shorter in the GA + EA group than in the GA alone group (16.0 vs. 20.5 min, p = 0.013). Conclusion Concomitant epidural anesthesia reduced by 15% the EC50 of predicted Ceprop for LOC, decreased the consumptions of propofol and remifentanil during maintenance of anesthesia, and fastened recovery from anesthesia. Clinical trial registration ClinicalTrials.gov, identifier: NCT05124704.
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Affiliation(s)
- Jiangling Wang
- Department of Anesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yajian Shen
- Department of Anesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenjing Guo
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wen Zhang
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiaoying Cui
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shunv Cai
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xinzhong Chen
- Department of Anesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Li Q, Ren Q, Luo Q, Yu X, Chen M, Wen Y, Huang L, Sun M, Yu S, Yang S. Research trends of acupuncture therapy on postoperative nausea and vomiting from 2011 to 2023: A bibliometric analysis. Complement Ther Med 2023; 78:102987. [PMID: 37741352 DOI: 10.1016/j.ctim.2023.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The utilization of acupuncture as a therapeutic intervention for the management of postoperative nausea and vomiting has experienced a notable increase in its popularity, and the purpose of this analysis is to provide a comprehensive understanding of the level of concern within the academic discipline and the main contributors and their partnership, as well as to identify research focal points and trends. METHODS A comprehensive search was carried out to identify relevant articles on the topic of acupuncture therapy for PONV in the Web of Science and China National Knowledge Internet. The search spanned from January 1, 2011, to June 6, 2023. The annual publications were count to see the degree of scholarly attention devoted to the discipline and how it has changed over time. A statistical analysis of article distribution across various journals was conducted to serve a rough indicator for assessing the quality of articles. And a bibliometric analysis was conducted using the software CiteSpace to visually analyze various aspects of the literature. Analyze authors, institutions and countries to identify the main contributors and their collaborative relationship; and analyze keywords and references to explore research hotspots and trends. RESULTS This study examined a comprehensive collection of 819 articles focused on acupuncture therapy for PONV, demonstrating a varying upward trend in the quantity of publications. Notably, the most productive author and institution were identified as Zheng Man and Guangzhou University of Traditional Chinese Medicine, respectively. While China had the highest number of publications, the United States held a greater prominence in this specific field. Collaboration among contributors was found to be weak. High-frequency keywords in the publications included "transcutaneous electrical acupoint stimulation," "electroacupuncture," "pain," and so forth. The literature with the highest citation count pertained to "Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting," while the article with the highest centrality was "Consensus Guidelines for the Management of Postoperative Nausea and Vomiting." Several large clusters obtained from the references are also included "postoperative pain," "transcutaneous electrical acupoint stimulation". Nothing pertaining to mechanism study was found in the analysis results. CONCLUSION The utilization of acupuncture for the treatment of postoperative nausea and vomiting has been gaining increasing recognition, although there remains room for improvement in the quality of research conducted in this area. Chinese authors and institutions have emerged as significant contributors to this field, while the United States has demonstrated greater proficiency in fostering collaborative efforts. It is imperative to enhance collaboration among these contributors. The current focal points of acupuncture for PONV encompass pain management, electroacupuncture, auricular acupuncture, and transcutaneous electrical acupoint stimulation. Additionally, TEA and enhanced recovery after surgery have been identified as the forefronts of research in this particular domain. In addition, there is still much room for research in the aspect of mechanism and insurance coverage. This study provides an in-depth perspective on acupuncture for PONV, which offers reference material for clinicians with rational choice of therapeutic scheme, educators with hot topics, and researchers with valuable research directions.
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Affiliation(s)
- Qian Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China; School of Health and Wellness, Panzhihua University, Panzhihua, China
| | - Qiang Ren
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Qin Luo
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Yu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ming Chen
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuheng Wen
- School of Health and Wellness, Panzhihua University, Panzhihua, China
| | - Liuyang Huang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingsheng Sun
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China; Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, China
| | - Shuguang Yu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sha Yang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China; Acupuncture-Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Messerer B, Stijic M, Sandner-Kiesling A, Brillinger JM, Helm J, Scheer J, Strohmeier CS, Avian A. Is PONV still a problem in pediatric surgery: a prospective study of what children tell us. Front Pediatr 2023; 11:1241304. [PMID: 37964809 PMCID: PMC10642485 DOI: 10.3389/fped.2023.1241304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. Methods A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. Results On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). Conclusions The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.
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Affiliation(s)
- Brigitte Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Marko Stijic
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- University Clinic for Neurology, Clinical Department for Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Andreas Sandner-Kiesling
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Johanna M. Brillinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jasmin Helm
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jacqueline Scheer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christof Stefan Strohmeier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Asgarlou Z, Mohammadian ED, Houshmandi S, Mohseni M, Sheyklo SG, Moosavi A, Ahmadi S. Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis. Int J Prev Med 2023; 14:116. [PMID: 38264568 PMCID: PMC10803683 DOI: 10.4103/ijpvm.ijpvm_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2024] Open
Abstract
Background Antiemetic medications have been associated with the prevention of nausea and vomiting in cesarean section, although less is known about the comparative efficacy of different medication classes. Methods We conducted a systematic review with network meta-analyses to compare and rank antiemetic medication classes (5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids, antihistamines, anticholinergic agents, sedatives, and opioid antagonists or partial agonists) in terms of preventing intra- and postoperative nausea and vomiting among patients undergoing cesarean section. We included all randomized controlled trials (RCTs) that evaluated any antiemetic medication classes' treatment for target outcomes. Network meta-analysis was conducted with a frequentist approach using the R netmeta package. A total of 58 trials were included (6,665 women undergoing cesarean section; mean age, 28.1 years). Results: Compared with placebo, all interventions reduced the odds of intraoperative nausea (except antihistamines), intraoperative vomiting (except antihistamines), postoperative nausea (except anticholinergic agents and opioid antagonists), and postoperative vomiting (except opioid antagonists). In terms of intraoperative nausea and both intra- and postoperative vomiting, sedatives ranked first among other medication classes. Conclusions The relative effect sizes for various classes of antiemetic medication in preventing nausea and vomiting in the cesarean section were modeled using the principles of network meta-analysis which may facilitate informed clinical decision-making.
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Affiliation(s)
- Zoleykha Asgarlou
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Sousan Houshmandi
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Mohseni
- Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sepideh Gareh Sheyklo
- Department of Obstetrics and Gynecology, Dezful University of Medical Sciences, Dezful, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Shiler Ahmadi
- Department of Nursing and Midwifery, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
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Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian H. The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34678. [PMID: 37657054 PMCID: PMC10476740 DOI: 10.1097/md.0000000000034678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of acupuncture by systematically reviewing the literature on colorectal cancer resection. METHODS Seven electronic databases were searched from inception to February 28, 2023. Randomized controlled trials on acupuncture in patients after CRC resection were included. Two reviewers independently selected relevant trials, extracted data, and assessed the risk of bias. A random-effects meta-analysis model was used to obtain summary effect estimates. The data were pooled and analyzed using RevMan 5.3. The heterogeneity of selected studies was evaluated by evaluating the I-squared (I2) statistics. RESULTS Twenty-two studies with 1878 patients were included. Results of the meta-analysis showed there was a low level evidence that acupuncture may improve early postoperative symptoms, such as time to first flatus (n = 876, MD -0.77h, 95% CI -1.22 to -0.33 h, I2 = 89%), time to first bowel movement (n = 671, MD -1.41h, 95% CI -2.20 to -0.63 h, I2 = 95%), time to first defecation (n = 556, MD -1.03h, 95% CI -1.88 to -0.18 h, I2 = 95%), and nausea/vomiting (n = 1488, RR 0.72, 95% CI 0.59-0.89, I2 = 49%) compared with usual care and sham acupuncture. However, there were no statistically significant differences in postoperative pain (n = 1188, MD-0.21, 95% CI -0.59 to 0.17, I2 = 74%). And there was no sufficient evidence of improving long-term functional outcomes. There was substantial heterogeneity across trials. The adverse events associated with acupuncture stimulation were minor in include studies. CONCLUSION SUBSECTIONS There is currently low-level evidence supporting the use of acupuncture on postoperative symptoms for patients after colorectal cancer resection. More investigations should be established based on the STRICTA statement strictly.
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Affiliation(s)
- Lin Qi
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongshuo Shi
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yunsong Zhang
- The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Hongling Jia
- The Second Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, China
| | - Hu Tian
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Tomczak S, Chmielewski M, Szkudlarek J, Jelińska A. Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures. Pharmaceutics 2023; 15:2143. [PMID: 37631357 PMCID: PMC10459602 DOI: 10.3390/pharmaceutics15082143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Chemotherapy-induced nausea and vomiting are defined as the most common of side effects of treatment and, at the same time, are very difficult to accept for patients', frequently causing changes in the therapy regimen, significantly reducing its effectiveness. Thus, an antiemetic prophylactic is essential to the provision of such a therapy for the patient. Pharmacotherapy often includes various drugs, including antiemetics, with the administration of such drugs by injection through two separate catheters being the preferred method. However, the co-administration of drugs and parenteral nutrition admixtures (PNAs) requires the consideration of compatibility, stability and potential negative interactions. To meet the purposes of clinical pharmacy, a compatibility test of ondansetron, dexamethasone and hydrocortisone with paediatric PNAs was conducted. PNAs differ in the composition of amino acid source (Primene® or Aminoplasmal Paed® 10%) and the type of injectable lipid emulsion (Lipidem® 200 mg/mL, Clinoleic® 20%, SMOFlipid® 200 mg/mL, Intralipid® 20%). An in vitro evaluation was performed in a static way as a simulated co-administration through a Y-site. The drug PNA ratios were determined based on the extreme infusion rates contained in the characteristics of medicinal products. All calculations were performed for a hypothetical patient aged 7 years weighing 24 kg. As a result of this study, it can be concluded that all tested PNAs showed the required stability in the range of parameters such as pH, osmolality, turbidity, zeta potential, MDD and homogeneity. The co-administration of antiemetic drugs does not adversely affect lipid emulsion stability. This combination was consistently compatible during the evaluation period.
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Affiliation(s)
- Szymon Tomczak
- Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznań, Poland
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Chung HW, Chang H, Hong D, Yun HJ, Chung HS. Optimal ropivacaine concentration for ultrasound-guided erector spinae plane block in patients who underwent video-assisted thoracoscopic lobectomy surgery. Niger J Clin Pract 2023; 26:1139-1146. [PMID: 37635608 DOI: 10.4103/njcp.njcp_63_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background An ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective way to control postoperative pain and may be a good alternative way to an epidural block. However, relevant research on the appropriate concentration of local anesthetics for an ESPB remains scarce. Aims This study aimed to investigate the optimal concentration of ropivacaine for an ESPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods A total of 68 patients who underwent a VATS lobectomy were enrolled. An ipsilateral ultrasound-guided ESPB was performed with three different ropivacaine concentrations as a local anesthetic: 0.189% (G1), 0.375% (G2), and 0.556% (G3). The total amount of perioperative remifentanil administered, patient-controlled analgesia (PCA) applied, and rescue drugs for postoperative analgesia during the 24 h after surgery were acquired, and numeric rating scale (NRS) scores were obtained. Results The total amount of intraoperative remifentanil administered was 7.20 ± 3.04 mcg/kg, 5.32 ± 2.70 mcg/kg, and 4.60 ± 1.75 in the G1, G2, and G3 groups, respectively. G2 and G3 had significantly lower amounts of remifentanil administered than the G1 group (P = 0.02 vs. G2; P = 0.003 vs. G3). The G3 group needed more inotropes than the G1 and G2 groups in the perioperative period (P = 0.045). The NRS scores, PCA, and rescue drug were not significantly different in the three groups. Conclusion The optimal concentration of ropivacaine recommended for an ESPB was 0.375%, which was effective in controlling pain and reducing the intraoperative opioid requirements with minimal adverse reactions such as hypotension.
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Affiliation(s)
- H W Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H Chang
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D Hong
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H J Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ha NY, Park MJ, Kim J. Chinese herbal medicine as adjuvant treatment for postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e072499. [PMID: 37380209 PMCID: PMC10410898 DOI: 10.1136/bmjopen-2023-072499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Postoperative nausea and vomiting (PONV) is a distressing symptom that patients often complain of even after less invasive surgery such as laparoscopic surgery (LS). If PONV is not well managed, patient recovery and postoperative quality of life are adversely affected. Although various drugs have been administered to prevent PONV, their effectiveness is limited, and adverse effects are numerous. Although herbal medicines have been widely used to manage various gastrointestinal symptoms, including nausea and vomiting, scientific evidence of their effects is lacking. This protocol is intended for a systematic review to analyse the efficacy and safety of Chinese herbal medicines for PONV after LS through a meta-analysis. METHODS AND ANALYSIS Randomised controlled trials, reported until June 2022, will be retrieved from electronic databases such as Medline, EMBASE and Cochrane Library. We will compare the effects of herbal medicine in patients presenting with PONV after LS with those of Western medicine, placebo and no treatment. If sufficient studies are identified, we will evaluate the combined effects of herbal and Western medicine. The incidence of nausea and vomiting will be considered the primary outcome. Secondary outcomes will include the intensity of complaints, quality of life and incidence of adverse events. Two independent reviewers will collect data based on the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, evaluate the quality of each study using the Cochrane risk-of-bias tool and synthesise the results via meta-analysis, if possible. ETHICS AND DISSEMINATION Ethical approval is not required for this review. The results of this study will be disseminated to peer-reviewed journals and posters. PROSPERO REGISTRATION NUMBER CRD42022345749.
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Affiliation(s)
- Na-Yeon Ha
- Division of Digestive Diseases, Department of Internal Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
| | - Mu-Jin Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Jinsung Kim
- Department of Gastroenterology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
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Yan S, Xu M, Zou X, Xiong Z, Li H, Yang J, Cao W, Zhu Z, Liu C. Acupuncture combined with ondansetron for prevention of postoperative nausea and vomiting in high-risk patients undergoing laparoscopic gynaecological surgery: A randomised controlled trial. United European Gastroenterol J 2023. [PMID: 37318120 DOI: 10.1002/ueg2.12421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Consensus guidelines recommend the use of multiple antiemetics as prophylaxis in patients at high risk of postoperative nausea and vomiting (PONV), but the evidence regarding combining acupuncture and antiemetics as a multimodal approach was of very low quality. OBJECTIVE This study aimed to assess the effect of combinations of acupuncture with ondansetron versus ondansetron alone for PONV prophylaxis in women at a high risk. METHODS This parallel, randomised controlled trial was conducted in a tertiary hospital in China. Patients who had three or four PONV risk factors on the Apfel simplified risk score, undergoing elective laparoscopic gynaecological surgery for benign pathology, were recruited. Patients in the combination group received two sessions of acupuncture treatment and 8 mg intravenous ondansetron, whereas those in the ondansetron group received ondansetron alone. The primary outcome was the incidence of PONV within 24 h postoperatively. Secondary outcomes included the incidence of postoperative nausea, postoperative vomiting, adverse events etc. RESULTS: Between January and July 2021, a total of 212 women were recruited, 91 patients in the combination group and 93 patients in the ondansetron group were included in the modified intention-to-treat analysis. In the first 24 h postoperatively, 44.0% of the patients in the combination group and 60.2% of the patients in the ondansetron group experienced nausea, vomiting, or both (difference, -16.3% [95% CI, -30.5 to -2.0]; risk ratio, 0.73 [95% CI, 0.55-0.97]; p = 0.03). However, the results of the secondary outcomes showed that compared to ondansetron alone, acupuncture together with ondansetron was only effective in reducing nausea but did not have a significant impact on vomiting. The incidence of adverse events was similar between the groups. CONCLUSION Acupuncture combined with ondansetron as a multimodal prophylaxis approach is more effective than ondansetron alone in preventing postoperative nausea in high-risk patients.
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Affiliation(s)
- Shiyan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjun Xu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Xuan Zou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hewen Li
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wenchao Cao
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Ziqiong Zhu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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McGinigle KL, Spangler EL, Ayyash K, Arya S, Settembrini AM, Thomas MM, Dell KE, Swiderski IJ, Davies MG, Setacci C, Urman RD, Howell SJ, Garg J, Ljungvist O, de Boer HD. A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2023; 77:1295-1315. [PMID: 36931611 DOI: 10.1016/j.jvs.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/17/2023]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.
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Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Olle Ljungvist
- Department of Surgery, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine, and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
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Ursavaş FE, Baksi A, Sarıca E. Postoperative Nausea and Vomiting After Orthopaedic Surgery: Prevalence and Associated Factors. Orthop Nurs 2023; 42:179-187. [PMID: 37262378 DOI: 10.1097/nor.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) is a common complication after surgery and can lead to additional complications and delayed discharge. This descriptive, cross-sectional study assessed the prevalence of PONV and its associated factors in patients undergoing orthopaedic surgery. The study was conducted between November 2020 and July 2021 with 149 patients in a public hospital in the Central Anatolia region of Turkey. In the first 48 hours after surgery, 40.9% of the patients had nausea and 17.4% had vomiting. Gender, age, medical diagnosis, surgical procedure, operative time, postoperative opioid use, and anxiety were identified as significant risk factors for PONV after orthopaedic surgery (p < .05). These factors should be considered during postoperative follow-up, and patients who are older, female, and have prolonged operative time or anxiety should be monitored more closely for PONV.
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Affiliation(s)
- Figen Erol Ursavaş
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
| | - Altun Baksi
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
| | - Emine Sarıca
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
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Ongel E, Erdag E, Adiyeke E, Bakan N. Acupressure Versus Ondansetron Usage for Postoperative Nausea and Vomiting After Gynecologic Surgeries. Cureus 2023; 15:e36862. [PMID: 37123721 PMCID: PMC10147480 DOI: 10.7759/cureus.36862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Anti-emetic interventions include pharmacologic and non-pharmacologic strategies. Acupressure is a non-pharmacologic and non-invasive therapeutic method that involves applying physical pressure to acupuncture points with fingers or devices. The pericardium (PC6) acupoint is located on the palm side of the wrist between the palmaris longus and flexor carpi radialis tendons, three fingers across the wrist starting at the wrist crease. Our first aim was to assess the effect of PC6 point acupressure on PONV after gynecological surgeries compared to intravenous (IV) ondansetron. Secondly, we aimed to assess the factors associated with the first and second hours (early) postoperative nausea scores. Methods This was a prospective, randomized, and single-centered intervention study conducted between November 1, 2022, and December 31, 2022, in a tertiary care hospital. Sancaktepe Martyr Prof. Dr. Ilhan Varank Education and Research Hospital Ethical Committee provided ethical approval for this study on October 14, 2022 (No: E-46059653-020). Randomization was done using the lottery method. Patients, who were over the age of 18 with an American Society of Anesthesiologists (ASA) physical score of I, II, or III status and had undergone gynecologic surgery under general anesthesia, were included. Patients, who were ASA IV, under continuous use of opioids or corticoids, underwent surgery with regional anesthesia, or declined to participate in the study, were excluded. There were two comparisons in this study. First, we divided patients into two groups according to anti-emetic prevention. Patients, who received IV 4 mg ondansetron (Group O), and patients, who placed acupressure bands at the P6 points on both forearms (Group B). The second comparison was done to assess the factors associated with early postoperative nausea. Patients were divided into two groups according to the mean early postoperative nausea scores as low (< 4, Group 1) and high/moderate (≥ 4, Group 2). PONV and pain scores were collected at five-time points: the first, second, sixth, twelfth, and twenty-fourth hours after surgery. Results Of 102 patients, 50 were in Group O and 52 were in Group B. There was no significant difference in postoperative pain, nausea, and vomiting scores. Fifty patients (50%), including 24 patients (48%) in Group O and 26 patients (52%) in Group B, experienced early moderate/high postoperative nausea in our study. According to the second comparison, 52 patients were in Group 1, and 50 patients were in Group 2. Operation time; first and second-hour pain scores; first, second, sixth, twelfth, and twenty-fourth-hour scores; and first and second-hour vomiting scores were all significantly different across groups. Conclusion The effect of PC6 point acupressure on early PONV compared to IV ondansetron was similar after gynecological surgeries. However, using only one anti-emetic treatment did not adequately relieve early PONV. Of all patients, 11 (10%) required an extra anti-emetic medication at the ward. 50% of patients experienced early moderate/high postoperative nausea in our study. Motion sickness history, operation time, and early postoperative pain scores were associated with early PONV.
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Qin J, Ye X, Ye C, Huang X, Sun H, Zhao X, Tong Y, Mazomba M, Mo Y. The Effect of Transcutaneous Electrical Acupoint Stimulation on High-Risk Patients with PONV Undergoing Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12031192. [PMID: 36769839 PMCID: PMC9917901 DOI: 10.3390/jcm12031192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is one of the most common complications after general anesthesia. The traditional comprehensive management of PONV usually uses one or two drugs, but this regimen fails to meet the requirements of the latest version of PONV guidelines. The purpose of this study was to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on high-risk PONV patients who are undergoing laparoscopic gynecological surgery. METHODS In total, 162 high-risk PONV patients were randomly divided into an experimental group (n = 81) and a control group (n = 81). Both groups were injected with 4 mg of dexamethasone and 0.25 mg of palonosetron. In the experimental group, Nei-guan (PC6) and He-gu (LI4) were stimulated by a transcutaneous acupoint electrical stimulation instrument (HANS200E) 30 min before the surgery. The control group also received electrodes but no stimulation. Variance analysis and rank sum test were used to compare the differences between the two groups. RESULTS The results of the incidence of postoperative nausea, vomiting, NRS score, degree of abdominal distension, and time to first flatus in the experimental group were lower than those in the control group. Nursing satisfaction of the experimental group was higher than that of the control group. CONCLUSIONS The study demonstrates that TEAS combined with dexamethasone and palonosetron can effectively prevent PONV, reduce postoperative abdominal distension and postoperative pain, and shorten the first postoperative flatus time in high-risk patients with PONV. At the same time, it can improve nursing satisfaction.
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Affiliation(s)
- Jiazhu Qin
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoxiao Ye
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Changzhou Ye
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xuliang Huang
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Huanhuan Sun
- Anesthesia Department, Taizhou Hospital of Zhejiang Province, Taizhou 318000, China
| | - Xinyu Zhao
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yao Tong
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Manala Mazomba
- Institute of International Education, Wenzhou Medical University, Ouhai District, Wenzhou 325000, China
| | - Yunchang Mo
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: ; Tel.: +86-577-88069790
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Lee S, You AH, Kim M, Kang HY. Postoperative Nausea and Vomiting According to Target-Controlled or Manual Remifentanil Infusion in Gynecological Patients Undergoing Pelviscopic Surgery: A Randomized Controlled Trial. J Pers Med 2023; 13:jpm13020176. [PMID: 36836410 PMCID: PMC9966727 DOI: 10.3390/jpm13020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/08/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We compared the incidence of postoperative nausea and vomiting (PONV) and postoperative outcomes, according to the remifentanil infusion method, during surgery in patients with a high-risk of PONV. METHODS Ninety patients undergoing elective gynecological pelviscopic surgery were randomly allocated to either target-controlled infusion (TCI, T) or manual (M) infusion. The primary outcome was the incidence of PONV until postoperative day (POD) 2. The secondary outcomes were perioperative heart rate (HR), blood pressure (BP), numerical rating scale pain scores up to POD2, and postoperative hospital length of stay. RESULTS Forty-four patients in the T group and 45 patients in the M group were analyzed. The total dose of remifentanil infusion was significantly higher in the T group (T group: 0.093 (0.078-0.112) μg/kg/min; M group: 0.062 (0.052-0.076) µg/kg/min, p < 0.001). Within POD2, the overall PONV was not significantly different (27 (61.4%) vs. 27 (60.0%), p = 0.895). The HR (82 ± 11.5/min vs. 87 ± 11.1/min, p = 0.046) and mean BP (83 ± 17.2 mmHg vs. 90 ± 16.7 mmHg, p = 0.035) were significantly lower in the T group after tracheal intubation. The other postoperative outcomes were comparable between the two groups. CONCLUSIONS Although the total remifentanil infusion dose was higher in the T group than in the M group, the postoperative outcomes were similar. If stable vital signs are desired during tracheal intubation, remifentanil infusion with TCI should be considered.
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Affiliation(s)
| | | | | | - Hee Yong Kang
- Correspondence: ; Tel.: +82-2-958-8589; Fax: +82-2-958-8580
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Shim JG, Ryu KH, Cho EA, Ahn JH, Cha YB, Lim G, Lee SH. Machine learning for prediction of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. PLoS One 2022; 17:e0277957. [PMID: 36548346 PMCID: PMC9778492 DOI: 10.1371/journal.pone.0277957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a still highly relevant problem and is known to be a distressing side effect in patients. The aim of this study was to develop a machine learning model to predict PONV up to 24 h with fentanyl-based intravenous patient-controlled analgesia (IV-PCA). METHODS From July 2019 and July 2020, data from 2,149 patients who received fentanyl-based IV-PCA for analgesia after non-cardiac surgery under general anesthesia were applied to develop predictive models. The rates of PONV at 1 day after surgery were measured according to patient characteristics as well as anesthetic, surgical, or PCA-related factors. All statistical analyses and computations were performed using the R software. RESULTS A total of 2,149 patients were enrolled in this study, 337 of whom (15.7%) experienced PONV. After applying the machine-learning algorithm and Apfel model to the test dataset to predict PONV, we found that the area under the receiver operating characteristic curve using logistic regression was 0.576 (95% confidence interval [CI], 0.520-0.633), k-nearest neighbor was 0.597 (95% CI, 0.537-0.656), decision tree was 0.561 (95% CI, 0.498-0.625), random forest was 0.610 (95% CI, 0.552-0.668), gradient boosting machine was 0.580 (95% CI, 0.520-0.639), support vector machine was 0.649 (95% CI, 0.592-0.707), artificial neural network was 0.686 (95% CI, 0.630-0.742), and Apfel model was 0.643 (95% CI, 0.596-0.690). CONCLUSIONS We developed and validated machine learning models for predicting PONV in the first 24 h. The machine learning model showed better performance than the Apfel model in predicting PONV.
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Affiliation(s)
- Jae-Geum Shim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Byeong Cha
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goeun Lim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Qian Y, Huang Z, Wang G, Han J, Zhou D, Ding H, Zhang X. Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting. Front Pharmacol 2022; 13:1050847. [PMID: 36506515 PMCID: PMC9733904 DOI: 10.3389/fphar.2022.1050847] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (<2 h) under general anesthesia were recruited in this study, and randomly assigned into two groups: Group N (patients receiving naloxone and Group C (patients receiving vehicle). Sufentanil (0.5 μg/kg within 5 s) was given in anesthesia induction, and low-dose naloxone (1.25 μg/kg) or identical vehicle was initially injected 5 min prior to induction, with the incidence and severity of SIC estimated. Subsequently, naloxone or vehicle was continuously infused at the rate of 0.5 μg/kg/h in the initiation of operation until the end of the operation, and the transverse abdominal fascia block (TAP) was performed for postoperative analgesia. The PONV profiles such as incidence and the severity, grading, and the frequencies of antiemetic usage within 24 h were evaluated, with VAS scores and remedial measures for analgesia during the first 24 h postoperatively were recorded. Our results revealed that one bolus of low-dose naloxone prior to the induction significantly mitigated the incidence of SIC, and intraoperative continuous infusion of low-dose naloxone reduced the incidence and the severity of PONV, so that the postoperative VAS scores and further remedial analgesia were not altered. These results not only provide clinical solutions for prophylaxis of SIC and PONV, but also suggests that opioids may act as a key role in both SIC and PONV, whereas opioid antagonist may hit two tasks with one stone. Moreover, further investigations are required to address the underlying mechanism of SIC and PONV. Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2200064865].
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Affiliation(s)
- Yiling Qian
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhifei Huang
- Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Guilong Wang
- Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jinghong Han
- Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Difei Zhou
- Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Hailei Ding
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, Jiangsu, China,*Correspondence: Xin Zhang, ; Hailei Ding,
| | - Xin Zhang
- Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China,Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States,*Correspondence: Xin Zhang, ; Hailei Ding,
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Park JM. Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study. Medicine (Baltimore) 2022; 101:e31393. [PMID: 36316835 PMCID: PMC9622572 DOI: 10.1097/md.0000000000031393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.
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Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- *Correspondence: Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Bukgu, Daegu 41404, South Korea (e-mail: )
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Yi F, Xiao H, Zhu T, Man Y, Ji F. Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study. BMC Anesthesiol 2022; 22:292. [PMID: 36109691 PMCID: PMC9476338 DOI: 10.1186/s12871-022-01835-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To observe the effect of different antiemetic drugs for the prevention of postoperative nausea and vomiting (PONV) after gynaecological day surgery under remimazolam general anesthesia. Methods One hundred ninety-two patients were selected for gynaecological day surgery and randomly divided into three groups: droperidol group (DD group), tropisetron group (DT group) and control group (DC group). Flurbiprofen axetil 50 mg and dexamethasone 5 mg were given intravenously before induction of anesthesia, and 2 min later droperidol 1 mg was given intravenously to the DD group, tropisetron 5 mg to the DT group and saline (5 ml) to the DC group. Induction of anesthesia: remimazolam 6 mg/kg/h was continuously infused until sleep, mivacurium 0.2 mg/kg and alfentanil 20ug/kg were slowly pushed, 3 min later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1 mg/kg/h of remimazolam continuous infusion. After awakening and extubation, the patient was transferred to the PACU. PONV were recorded in the PACU and an electronic questionnaire was pushed 24 h after surgery. Results The incidence of PONV within the PACU was significantly lower in the DD (14.5%)and DT(26.7%) groups than in the DC(50%) group (p < 0.01), there was no significantly difference between the DT and DD groups. There were no significant difference in the incidence of PONV in 24 h after surgery between the three groups(DD:DT:DC = 44.5%:45.1%:63.8%,p > 0.05). Conclusions Droperidol or tropisetron combined with dexamethasone is superior to dexamethasone alone for the prevention of PONV in the PACU after remimazolam combined with alfentanil anesthesia, with no significant difference in the incidence of PONV in 24 h after surgery.
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[Bipolar androgen therapy followed by immune checkpoint inhibitors in metastatic castration resistant prostate cancer: A report of 4 cases]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 35950406 PMCID: PMC9385506 DOI: 10.19723/j.issn.1671-167x.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The relationship between androgen and prostate cancer treatment has plagued the field of urologic oncology. To investigate the efficacy and safety of bipolar androgen therapy (BAT) followed by immune checkpoint inhibitor therapy in patients with metastatic castration resistant prostate cancer (mCRPC). In August 2020, Beijing Hospital conducted an investigator-initiated study: Bipolar androgen therapy followed by immune checkpoint inhibitor therapy in metastatic castration resistant prostate cancer. Up to now, the study has included 4 patients who completed the entire cycle of treatment. The mean age of the patients was 74.5 (68 to 82) years old, the mean prostate-specific antigen (PSA) was 20.8 (9.9 to 8.36) μg/L, the mean testosterone was 0.50 (0.00 to 1.81) μg/L, and the Gleason score were 10 and 9, 7, 7 respectively. The pain scale score before treatment was 1.5 (1 to 2). In this study, 4 patients completed the entire cycle of treatment, and the treatment effect of the patients showed great heterogeneity. PSA in case 1 decreased from 24.0 μg/L to 0.47 μg/L, testosterone increased from 0.175 6 μg/L to 2.62 μg/L. PSA in case 2 increased from 9.939 μg/L to 168.536 μg/L, and testosterone increased from 0.0 μg/L increased to 2.85 μg/L. PSA increased from 13.31 μg/L to 39.278 μg/L in case 3, testosterone increased from 0.0 μg/L to 2.54 μg/L. and PSA increased from 36.0 μg/L to 350.2 μg/L in the case 4, testosterone increased from 1.81 μg/L to 3.85 μg/L. Except for one patient who showed significant PSA remission, the PSA levels of the remaining three patients remained high overall. There were no adverse reactions reported in 4 patients. In the follow-up, case 1 continued to use PD-1 monoclonal antibody (median progression free survival time was 10 months). Two patients who had previously been resistant to enzalutamide received enzalutamide again after the whole cycle of treatment, and their PSA decreased again, which indicated that the patient was sensitive to enzalutamide again. BAT had a certain therapeutic effect on mCRPC patients, and the safety was controllable. Its tumor control effect still needed long-term follow-up verification in large-sample clinical trials. BAT has a certain therapeutic effect on mCRPC patient, especially the resensitivity of tumors to enzalutamide can be restored. Immune checkpoint inhibitors may have therapeutic potential in patients with prostate cancer treated with BAT and enzalutamide.
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康 志, 王 磊, 韩 永, 郭 向. [Anesthesia management of athletes' operation in Beijing Olympic Winter Games]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:770-773. [PMID: 35950407 PMCID: PMC9385508 DOI: 10.19723/j.issn.1671-167x.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 06/15/2023]
Abstract
According to literature reports, the injury rate of the athletes in Olympic Winter Games recent years was as high as 10%-14%. Combined with the background of corona virus disease 2019 (COVID-19), the medical insurance work of the 24th Olympic Winter Games held in Beijing had put forward more complicated requirements and more severe challenges. In order to better optimize anesthesia management, this article summarized the perioperative treatment of athletes in Olympic Winter Games, the safety protection strategy of medical staff under general anesthesia, and the potential impact of peri-operative drugs on athletes. Anesthesiologists, as the core members of the rescue team, should be familiar with the particularity of operative anesthesia of athletes, sum up relevant experience to ensure the safety of perioperative patients. So all kinds of technical measures should be taken in the process of operation to minimize the indoor pollution caused by the patient's cough. For example, all the patients should wear N95 masks from the ward to the operating room, and after the operation, wear the N95 masks back to the ward. Although the International Olympic Committee had banned more than 200 drugs for participants and athletes who had to strictly follow International Olympic Committee requirements during anesthesia, the athletes were no longer participating in this Olympic Winter Games, so opioids (sufentanil and remifentanil) and glucocorticoid (dexamethasone) could be used according to the actual needs of surgery and anesthesia. Five athletes in Yanqing competition area underwent surgical anesthesia in Peking University Third Hospital Yanqing Hospital. All the five patients received general anesthesia, of whom four underwent orthopaedic surgery and one underwent laparoscopic cholecystectomy. General anesthesia with laryngeal mask airway was the first choice in the five patients. And the pain after orthopaedic surgery was severe and nerve block technique could effectively relieve the pain after surgery. Three patients received ultrasound-guided nerve block analgesia, the postoperative analgesia lasted 36 h. After the operation, non-steroidal anti-inflammatory drug (NSAID) was infused intravenously in the ward and all the patients recovered uneventfully. As the core member of the trauma rescue team, anesthesiologists should be familiar with the particularity of the athletes' surgical anesthesia, do a good job in medical security, and summarize relevant experience to ensure the life safety of the perioperative patients.
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Affiliation(s)
- 志宇 康
- 北京大学第三医院延庆医院麻醉科, 北京 102100Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing 102100, China
| | - 磊磊 王
- 北京大学第三医院延庆医院麻醉科, 北京 102100Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing 102100, China
| | - 永正 韩
- 北京大学第三医院麻醉科, 北京 100191Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - 向阳 郭
- 北京大学第三医院麻醉科, 北京 100191Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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Jaszczuk S, Natarajan S, Papalois V. Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review. J Clin Med 2022; 11:3435. [PMID: 35743505 PMCID: PMC9225521 DOI: 10.3390/jcm11123435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 02/01/2023] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols are designed to reduce medical complications, the length of hospital stays (LoS), and healthcare costs. ERAS is considered safe and effective for kidney transplant (KTx) surgery. KTx recipients are often frail with multiple comorbidities. As these patients follow an extensive diagnostic pathway preoperatively, the ERAS protocol can ideally be implemented at this stage. Small singular changes in a long perioperative pathway can result in significant positive outcomes. We have investigated the current evidence for an ERAS pathway related to anaesthetic considerations in renal transplant surgery for adult recipients.
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Affiliation(s)
| | - Shweta Natarajan
- Department of Anaesthesia, Imperial College, London W12 0HS, UK;
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Barzanji A, Nasseri K, Sadeghi S, Ardalan M, Nouri B, Daseh K. Comparing the Effect of Ondansetron-dexamethasone and Metoclopramide-dexamethasone on Postoperative Nausea and Vomiting after Gynecological Laparoscopy: A Randomized Double-blind Clinical Trial. Adv Biomed Res 2022; 11:44. [PMID: 35814298 PMCID: PMC9259444 DOI: 10.4103/abr.abr_251_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/11/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Nausea and vomiting is a common complication after gynecological surgeries, especially laparoscopy, which can lead to discomfort and restlessness in the patients. The aim of the study was to compare the effect of ondansetron-dexamethasone and metoclopramide-dexamethasone on postoperative nausea and vomiting following gynecological laparoscopy. Materials and Methods In this double-blind clinical trial, 68 females scheduled for gynecological laparoscopy and age range of 18-40 years were randomly divided into two groups. Group OD received ondansetron 4 mg plus dexamethasone 8 mg and group MD received metoclopramide 10 mg plus dexamethasone 8 mg, 15 min before the end of surgery. The incidence of nausea and vomiting and need for rescue medication was assessed during the recovery period, as well as at 2, 4, 6, 12, and 24 h after surgery. The data were analyzed using STATA software version 12 and a significance level of <0.05 was considered in this research. Results The incidence of nausea in ondansetron and metoclopramide groups was 23.3% and 33.3%, respectively, and the frequency of vomiting was 10% and 16.6%, respectively, which showed no significant difference (P > 0.05). The highest incidence of nausea and vomiting in patients belonged to the metoclopramide group inside 4-6 h after surgery. Conclusion Our study showed that no significant difference was observed in the incidence of nausea and vomiting between ondansetron-dexamethasone and metoclopramide-dexamethasone groups following laparoscopic gynecological surgery; however, the number of patients with nausea and vomiting was lower in the ondansetron-dexamethasone group.
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Affiliation(s)
- Arvin Barzanji
- Department of Anesthesiology, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences,Sanandaj, Iran
| | - Karim Nasseri
- Department of Anesthesiology, Faculty of Medicine, Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences,Sanandaj, Iran
| | - Shahram Sadeghi
- Spiritual Health Research Center, Health Development Research Institute, Kurdistan University of Medical Sciences,Sanandaj, Iran
| | - Mahsa Ardalan
- Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bijan Nouri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khadijeh Daseh
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Wong SSC, Choi EKY, Chan WS, Cheung CW. Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: a large-scale retrospective study with covariate adjustment. BMC Anesthesiol 2022; 22:140. [PMID: 35538421 PMCID: PMC9088064 DOI: 10.1186/s12871-022-01683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background To compare the postoperative analgesic effect of propofol total intravenous anaesthesia (TIVA) versus inhalational anaesthesia (GAS) in patients using morphine patient-controlled analgesia (PCA). Methods A retrospective cohort study was performed in a single tertiary university hospital. Adult patients who used PCA morphine after general anaesthesia across 15 types of surgeries were included. Patients who received propofol TIVA were compared to those who had inhalational anaesthesia. Primary outcomes assessed were postoperative numerical rating scale (NRS) pain scores and postoperative opioid consumption. Results Data from 4202 patients were analysed. The overall adjusted NRS pain scores were significantly lower in patients who received propofol TIVA at rest (GEE: β estimate of the mean on a 0 to 10 scale = -0.56, 95% CI = (-0.74 to -0.38), p < 0.001; GAS as reference group) and with movement (β estimate = -0.89, 95% CI = (-1.1 to -0.69), p < 0.001) from postoperative days (POD) 1–3. Propofol TIVA was associated with lower overall adjusted postoperative morphine consumption (β estimate = -3.45, 95% CI = (-4.46 to -2.44), p < 0.001). Patients with propofol TIVA had lower adjusted NRS pain scores with movement for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p < 0.001) and urological surgeries (p = 0.005); and less adjusted postoperative morphine consumption for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p = 0.006) and urological surgeries (p = 0.002). There were no differences for other types of surgeries. Conclusion Propofol TIVA was associated with statistically significant, but small reduction in pain scores and opioid consumption in patients using PCA morphine. Subgroup analysis suggests clinically meaningful analgesia possibly for hepatobiliary/pancreatic and upper gastrointestinal surgeries. Trial registration This study is registered at ClinicalTrials.gov (NCT03875872). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01683-9.
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Affiliation(s)
- Stanley Sau Ching Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, HKSAR, Hong Kong, China. .,Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China.
| | - Edward Kwok Yiu Choi
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Wing Shing Chan
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, HKSAR, Hong Kong, China.,Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
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Effectiveness of Music Intervention on Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis. J Perianesth Nurs 2022; 37:717-727. [DOI: 10.1016/j.jopan.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022]
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Gao W, Zhang L, Han X, Wei L, Fang J, Zhang X, Zhang J, Wang H, Zhou Q, Wang C, Chen W, Ni X, Yang L, Du R, Wang G, Liu B, Li Y, Zhang S, Wang Q. Transcutaneous Electrical Acupoint Stimulation Decreases the Incidence of Postoperative Nausea and Vomiting After Laparoscopic Non-gastrointestinal Surgery: A Multi-Center Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:766244. [PMID: 35360742 PMCID: PMC8964119 DOI: 10.3389/fmed.2022.766244] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Postoperative nausea and vomiting (PONV) gives patients a bad experience and negates their good recovery from surgery. Objective This trial aims to assess the preventive effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on the incidence of PONV in high-risk surgical patients. Design The large sample size, multicenter, evaluator-blinded, and randomized controlled study was conducted between September 3, 2019 to February 6, 2021. Setting The 12 hospitals were from different Chinese provinces. Participants After obtaining ethics approval and written informed consent, 1,655 patients with Apfel score ≥ 3 points were enrolled for selective laparoscopic non-gastrointestinal surgery under general anesthesia. Interventions Patients were randomly allocated into the TEAS and Sham group with a 1:1 ratio. The TEAS group was stimulated on bilateral Neiguan and Zusanli acupoints after recovery from anesthesia on the surgical day and the next morning for 30 min, while the Sham group received an identical setting as TEAS but without currents delivered. Electronic patient self-reported scale was used to evaluate and record the occurrence of PONV. Main Outcomes and Measures Primary clinical end point is the incidence of PONV which was defined as at least one incidence of nausea, retching, or vomiting after operation within postoperative 24 h. Results Compared with the Sham treatment, the TEAS lowered the PONV incidence by 4.8% (29.4 vs. 34.2%, P = 0.036) and vomiting incidence by 7.4% (10.4 vs. 17.8%, P < 0.001). TEAS also lowered persistent nausea incidence and PONV scores and decreased PONV related complications and Quality of Recovery−40 scores (P < 0.05). TEAS lowered the 24 h PONV risk by 20% (OR, 0.80, 95% CI, 0.65 −0.98; P = 0.032), and lowered hazard ratio by 17% (HR, 0.83, 95% CI, 0.70–0.99; P = 0.035). Both TEAS and palonosetron were the independent PONV risk protective factors for 24 h PONV incidence and cumulative PONV incidence. The combination of TEAS and palonosetron was the most effective strategy to reduce the PONV incidence (P < 0.001). Conclusions and Relevance TEAS attenuated the PONV incidence and severity in high-risk surgical patients and may be applied clinically as a complement therapy to prevent PONV. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04043247, identifier: NCT04043247.
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Affiliation(s)
- Wei Gao
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linzhong Zhang
- Department of Anesthesiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xuechang Han
- Department of Anesthesiology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Lai Wei
- Department of Anesthesiology, Hunan Provincial People's Hospital, Changsha, China
| | - Jie Fang
- Department of Anesthesiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaqing Zhang
- Department of Anesthesiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiaqiang Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haiyun Wang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Qi Zhou
- Department of Anesthesiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Chenggang Wang
- Department of Anesthesiology, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, China
| | - Wenting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinli Ni
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Lan Yang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruini Du
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ge Wang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bingyu Liu
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajuan Li
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shanshan Zhang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Wang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Qiang Wang
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Hailu S, Mekonen S, Shiferaw A. Prevention and management of postoperative nausea and vomiting after cesarean section: A systematic literature review. Ann Med Surg (Lond) 2022; 75:103433. [PMID: 35386767 PMCID: PMC8977897 DOI: 10.1016/j.amsu.2022.103433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Post-operative nausea and vomiting (PONV) are a common post-operative problem in anesthesia. The incidence of PONV in patients undergoing cesarean sections is very high. Post-operative nausea and vomiting have many negative impacts on the patient, baby, family, and health care system. Therefore, appropriate evidence-based knowledge regarding the prevention and management of PONV for those high-risk patients is a timely and very important issue to address to decrease the associated complications. Methods A comprehensive literature search was conducted in Pubmed/Medline, Cochrane reviews, and google scholar including those studies published in the English language from 2010 up to 2021. The methodological quality of the included studies was appraised by the Cochrane risk of a biased assessment tool for intervention and non-interventional studies. Result The search strategy identified a total of 10,540 articles from different electronic databases. 33 articles were selected for screening after duplicates were removed; finally, 17 articles were included for critical appraisal and 16 articles were excluded with reasons. The included articles consist of 15 RCT, 1 non-control prospective cohort, and 1 cross-sectional study. Conclusion Pieces of evidence revealed that all obstetrics patients undergoing cesarean section should be given multimodal PONV prophylaxis. It is shown that a multimodal approach by a combination of different antiemetic agents should be preferred and most effective in preventing intraoperative and postoperative nausea and vomiting for patients undergoing cesarean section because of the complex pathophysiology of nausea and vomiting.
What are PONV prevention strategies for C/S? What are the treatment approaches for PONV after C/S? Which one is best option for the prevention of PONV after C/S?
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Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients Undergoing Same-day Surgery. J Perianesth Nurs 2022; 37:445-451. [DOI: 10.1016/j.jopan.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/20/2022]
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Stojanova J, Pérez-Bracchiglione J, Erridge S, Madrid E, Caracci B, Klabunde R, Franco JVA. Cannabis-based medicines for prevention of postoperative nausea and vomiting in adults. Hippokratia 2022. [DOI: 10.1002/14651858.cd014567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jana Stojanova
- Interdisciplinary Centre for Health Studies CIESAL, Universidad de Valparaíso; Valparaíso Chile
- Cochrane Chile Associate Centre, Universidad de Valparaíso; Valparaíso Chile
| | - Javier Pérez-Bracchiglione
- Interdisciplinary Centre for Health Studies CIESAL, Universidad de Valparaíso; Valparaíso Chile
- Cochrane Chile Associate Centre, Universidad de Valparaíso; Valparaíso Chile
| | - Simon Erridge
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Eva Madrid
- Cochrane Chile Associate Centre, Universidad de Valparaíso; Valparaíso Chile
- Interdisciplinary Centre for Health Studies CIESAL, Universidad de Valparaíso; Viña del Mar Chile
| | - Bruno Caracci
- Department of Anaesthesiology, Universidad de Valparaíso; Hospital Gustavo Fricke; Viña del Mar Chile
| | - Rachel Klabunde
- Cochrane Chile Associate Centre, Universidad de Valparaíso; Valparaíso Chile
| | - Juan VA Franco
- Associate Cochrane Centre; Instituto Universitario Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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