Management of postdischarge nausea and vomiting

Dziadzko, Mikhail; Aubrun, Frédéric

doi:10.1016/j.bpa.2020.10.008

Cited by 9 publications

(9 citation statements)

References 55 publications

(60 reference statements)

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“…The rate of ambulatory surgery varies between 30% and more than half of all surgery in high-income countries involving all age patients [ 1 , 2 ]. Postoperative pain management and nausea-vomiting are the main barriers for the successful outpatient track and are the main issues for the first 72 h after discharge [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

Dziadzko

Bouteleux

Minjard

et al. 2022

Trials

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Background Successful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects. Methods A total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge. Discussion The developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses. Trial registration ClinicalTrials.govNCT03754699. Registered on November 27, 2018.

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Section: Introductionmentioning

confidence: 99%

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

Dziadzko

Bouteleux

Minjard

et al. 2022

Trials

Self Cite

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“…A large body of literature confirms that the incidence of PONV is approximately 25 ~ 50% [ 14 ] and that post-discharge nausea and vomiting (PDNV) occurs in 30% of patients [ 15 ]. Despite the widespread use of anti-emetic drugs, short-acting anesthetic drugs and minimally invasive surgery in the clinic, the incidence of PONV is still 20 ~ 40% [ 16 , 17 ] and up to 80% in high-risk groups, mainly associated with increased day surgery and early activity and discharge after minor/major surgery [ 18 ].High risk factors for early PONV in the PACU are opioid administration, female gender, BMI > 35, major surgery, and duration of anesthesia over 60 min [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study

Xiao

Zhu

et al. 2022

BMC Anesthesiol

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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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“…A large body of literature con rms that the incidence of PONV is approximately 25 ~ 50% [12] and that post-discharge nausea and vomiting (PDNV) occurs in 30% of patients [13]. Despite the widespread use of anti-emetic drugs, short-acting anesthetic drugs and minimally invasive surgery in the clinic, the incidence of PONV is still 20 ~ 40% [14,15] and up to 80% in high-risk groups, mainly associated with increased day surgery and early activity and discharge after minor/major surgery [16].High risk factors for early PONV in the PACU are opioid application, female gender, BMI > 35, major surgery, and duration of anesthesia over 60 minutes.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia：A randomized double-blind controlled study

Xiao

Zhu

et al. 2022

Preprint

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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:192 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 50mg and dexamethasone 5mg were given intravenously before induction of anesthesia, and 2 minutes later droperidol 1mg was given intravenously to the DD group, tropisetron 5mg to the DT group and saline (5ml) to the DC group. Induction of anesthesia: remimazolam 6mg/kg/h was continuously pumped to sleep, mivacurium 0.2mg/kg and alfentanil 20ug/kg were slowly pushed, 3 minutes later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1mg/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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Management of postdischarge nausea and vomiting

Cited by 9 publications

References 55 publications

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia：A randomized double-blind controlled study

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