Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence

Gan, Tong J.; Jin, Zhaosheng; Meyer, Tricia A.

doi:10.1213/ane.0000000000006126

Cited by 11 publications

(2 citation statements)

References 80 publications

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“…12 The search for the best cost-effective approach to post-operative nausea and vomiting is far from complete. 20 Newer drugs have therefore been studied in preventing post-operative nausea and vomiting. Aprepitant, a neurokinin-1 antagonist, was observed to be significantly more effective than ondansetron for preventing vomiting at 24 and 48 hours after surgery, 21 but its superiority in preventing post-operative nausea and vomiting in combination with steroids is still unclear.…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Patient-reported nausea after implementation of an enhanced recovery after surgery protocol for gynae-oncology patients

Lindemann,

Heimisdottir Danbolt,

Ramberg

et al. 2023

Int J Gynecol Cancer

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ObjectivesThis study aimed to analyze the adherence to strategies to prevent post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) protocol for gynae-oncology patients. Patient-reported nausea before and after ERAS was also studied.MethodsThis prospective observational study included all patients undergoing laparotomy for a suspicious pelvic mass or confirmed advanced ovarian cancer before (pre-ERAS) and after the implementation of ERAS (post-ERAS) at Oslo University Hospital, Norway. Patients were a priori stratified according to the planned extent of surgery into two cohorts (Cohort 1: Surgery of advanced disease; Cohort 2: Surgery for a suspicious pelvic tumor). Clinical data including baseline characteristics and outcome data were prospectively collected.ResultsA total of 439 patients were included, 243 pre-ERAS and 196 post-ERAS. At baseline, 27% of the patients reported any grade of nausea. In the post-ERAS cohort, statistically significantly more patients received double post-operative nausea and vomiting prophylaxis (64% pre-ERAS vs 84% post-ERAS, p<0.0001). There was no difference in the need for rescue medication (82% pre-ERAS vs 79% post-ERAS; p=0.17) and no statistically significant difference between pre- and post-ERAS or between the surgical cohorts in patient-reported nausea of any grade on day 2. Patients who reported none/mild nausea on day 2 had significantly less peri-operative fluid administered during surgery than those who reported moderate or severe nausea (median 12.5 mL/kg/hour vs 16.5 mL/kg/hour, p=0.045) but, in multivariable analysis, fluid management did not remain significantly associated with nausea.ConclusionImplementation of an ERAS protocol increased the adherence to post-operative nausea and vomiting prevention guidelines. Nausea, both before and after laparotomy, remains an unmet clinical need of gynae-oncology patients also in an ERAS program. Patient-reported outcome measures warrant further investigation in the evaluation of ERAS.

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Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Patient-reported nausea after implementation of an enhanced recovery after surgery protocol for gynae-oncology patients

Lindemann,

Heimisdottir Danbolt,

Ramberg

et al. 2023

Int J Gynecol Cancer

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show abstract

“…Additionally, PONV can contribute to delayed recovery and pose life-threatening complications, including hospital-acquired pneumonia and thromboembolic events 10 . The management of PONV presents challenges due to its multifaceted etiology, encompassing patient characteristics, surgical factors, and anesthetic techniques, compounded by the variable response to prophylactic antiemetics 11 , 12 . Furthermore, the inconsistency in clinical practice guidelines exacerbates these challenges 13 .…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of prophylactic protocols in reducing perioperative nausea and vomiting during video-assisted thoracoscopic radical resection of lung cancer

Zhang,

Shen,

Jiang

et al. 2024

Sci Rep

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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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A Postoperative Nausea and Vomiting Update

Meyer¹,

Hutson²,

Morris³

et al. 2023

Advances in Anesthesia

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Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence

Cited by 11 publications

References 80 publications

Patient-reported nausea after implementation of an enhanced recovery after surgery protocol for gynae-oncology patients

Patient-reported nausea after implementation of an enhanced recovery after surgery protocol for gynae-oncology patients

Comparative efficacy of prophylactic protocols in reducing perioperative nausea and vomiting during video-assisted thoracoscopic radical resection of lung cancer

A Postoperative Nausea and Vomiting Update

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