Postoperative nausea and vomiting prevention: a literature review

RCSI Institute of Leadership

PONV

Literature Review Grid

Population / Sampling

Data Collection Tool

Validity / Reliability

Ethics

Risk Factors

Rate of occurrences

Prevention or Treatment

Theme

Rusch, Eberhart, Wallenborn, and Kranke (2010)

Systematic review of literature

Interpretive

High risk patients given multimodal prophylaxis. Immediate treatment to minimize risks.

Evidence-based measures of prevention and treatment

Latz, et al. (2010)

Postoperative nausea and vomiting was prospectively assessed within 24 hours after surgery

229 patients requiring supratentorial or infratentorial craniotomy observed incidence of vomiting was compared with the rate of vomiting predicted with a surgery-independent risk score observation comparison

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overall incidence of PONV after craniotomy was 47%

overall incidence of PONV within 24 hours after craniotomy was approximately 50%.

Gartner, et al. (2010)

prevention regimen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexamethasone, total intravenous anaesthesia and intraoperative ondansetron.

200 consecutive patients scheduled for breast cancer surgery patients were prospectively scored according to PONV, pain during rest and mobilization and major side effects.

Apfel postoperative vomiting score

PONV scoring n/a n/a n/a

During the first 36 postoperative hours, 79.1%

reported no PONV at all and only 3.7% reported severe PONV. At rest, 69.6%

reported no or light pain and 3.1% reported severe pain, with corresponding values of 59.7% and 8.9% during arm mobilization.

A multimodal, opiate-sparing regimen to prevent pain and PONV seems to be more effective than one- or two-component regimens on PONV.

Sussane, Arwestrom, Baker and Bertero (2010)

Qualitative approach using narratives.

Ten female nurses from two general surgical units

Interviews

hermeneutic narrative method interpretive n/a n/a n/a n/a

Nurses have various tools at their disposal to address and assist in the prevention of post-surgical PONV

Apfel, et al. (2010)

A systematic literature review.

search of PubMed, EMBASE, and the Cochrane Library for randomized controlled trials in adults

Effects of TDS and placebo on postoperative nausea, vomiting and PONV

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In the postanesthesia care unit, TDS was associated with a significantly reduced risk for postoperative nausea compared with placebo (relative risk [RR] = 0.77; 95% CI, 0.61-0.98; P = 0.03). TDS was also associated with a significantly reduced risk for postoperative nausea (RR = 0.59; 95% CI, 0.48-0.73; P < 0.001), postoperative vomiting (RR = 0.68; 95% CI, 0.61-0.76; P < 0.001), and PONV (RR = 0.73; 95% CI, 0.60-0.88; P = 0.001) during the first 24 hours after the start of anesthesia. TDS appeared to be effective compared with placebo in the prevention of postoperative nausea when treatment was initiated the night before (early application) (RR = 0.56; 95% CI, 0.41-0.75; P < 0.001) or on the day of surgery (late application) (RR = 0.61; 95% CI, 0.47-0.79; P < 0.001). TDS was associated with a higher prevalence of visual disturbances at 24 to 48 hours compared with placebo (RR = 3.35; 95% CI, 1.78-6.32)

Ornek, et al. (2010)

study

60 geriatric outpatient cases with ASA II-III physical status and requiring short duration transurethral intervention

Cases split into 2 groups: (1) general; and (3) selective spinal anesthesia

Group GA (n = 30) received propofol 2 mg kg-1 (until loss of eyelash reflex), remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg / kg-1 / min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30) received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg comparison n/a n/a

Source

Methodology

Population / Sampling

Data Collection

Data Collection Tool

Data Analysis

Validity / Reliability

Ethics

Risk Factors

Rate of occurrences

Prevention or Treatment

Theme 4

Korkut et al. (2010)

Prospective, randomized, controlled trial

104 adult patients

Group 1 and Group 2

Evaluation of PONV in patients in each group comparison n/a n/a

According to surgery type, the incidence of PONV after two hours was 71% in septorhinoplasty, 68% in endoscopic sinus surgery, and 50% in septoplasty; after four hours it was 59% in septorhinoplasty, 53% in endoscopic sinus surgery, and 37% in septoplasty; and after eight hours it was 35% in septorhinoplasty, 39% in endoscopic sinus surgery, and 21% in septoplasty. PONV was not seen at 24 hours significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used

Habib, et al. (2010)

prospective, double-blind, randomized study

104 Patients undergoing craniotomy

Patients were randomized to receive oral aprepitant 40 mg (or matching placebo) 1 to 3 hours before induction of anesthesia or ondansetron 4 mg IV (or placebo) within 30 minutes of the end of surgery.

Postoperative backache and dissatisfaction

The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%

Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.

Simurina et al. (2010)

Prospective, randomized, double-blinded, controlled study.

120 ASA physical status I and II women, aged 21 to 76 years, undergoing elective gynecologic laparoscopic surgery.

Patients were randomized to receive a gas mixture of 30% oxygen in air (FIO (2) = 0.3, Group G30), 50% oxygen in air (FIO (2) = 0.5, Group G50), or 80% oxygen in air (FIO (2) = 0.8, Group G80); there were 36 patients in each group. A standardized sevoflurane general anesthesia, postoperative pain management, and antiemetic regimen were used.

Frequency of nausea, vomiting, and both was assessed for early (0 to two hrs) and late PONV (two to 24 hrs), along with use of rescue antiemetic, degree of nausea, and severity of pain.

interpretive n/a n/a n/a

G80 patients had significantly less vomiting than Group G30 at two hours, 3% (1/36) vs. 22% (8/36), respectively, P = 0.028

High intraoperative FIO (2) of 0.8 and FIO (2) of 0.5 do not prevent PONV in patients without antiemetic prophylaxis. An intraoperative FIO (2) of 0.8 has a beneficial effect on early vomiting only.

Miyagawa et al. (2010)

A prospective cohort study design

Sixty-eight patients, aged between 20 and 80 years, were scheduled for a standardized general anaesthetic technique.

Patients who were given methylprednisolone were assigned as the steroid cover group, and those who were not given methylprednisolone formed the non-steroid cover group.

PONV were assessment by direct questioning or spontaneous complaints by patients 1 week after surgery. Postoperative pain was evaluated using Visual Analog Scale (VAS) 1 and 3 days after surgery.

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The incidence of nausea in the steroid cover group was significantly less than that in the non-steroid cover group (adjusted odds ratio, 0-17, P = 0 021), but there was no significant difference in vomiting between the two groups. Postoperative pain VAS score was not significantly different between groups

In total knee and hip arthroplasty, methylprednisolone is effective in preventing postoperative nausea; however, higher doses of methylprednisolone may be needed to prevent vomiting.

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