scholarly journals Pruritus and postoperative nausea and vomiting after intrathecal morphine in spinal anaesthesia for caesarean section: Prospective cohort study

2018 ◽  
Vol 27 (4) ◽  
pp. 251-255
Author(s):  
Yu Jia Thay ◽  
Qing Yuan Goh ◽  
Reena Nianlin Han ◽  
Rehena Sultana ◽  
Ban Leong Sng
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Intrathecal Morphine ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Maternal Satisfaction ◽  
Need For Treatment ◽  
Clinically Significant ◽  
Post Operative Nausea ◽  
A Prospective Study

Background: Spinal anaesthesia is a common anaesthetic technique for caesarean sections. Neuraxial opioids such as intrathecal morphine may cause common adverse effects (pruritus, post-operative nausea and vomiting). Objectives: We investigated the incidence, severity and need for treatment of pruritus and post-operative nausea and vomiting following administration of intrathecal morphine in spinal anaesthesia for caesarean section at KK Women’s and Children’s Hospital, Singapore. Methods: We conducted a prospective study involving 124 parturients who received intrathecal morphine in spinal anaesthesia for caesarean section from October 2012 to October 2014. Results: Seventy patients (56.5%) had moderate or severe pruritus (score 4–10), while 54 patients (43.5%) had no or mild pruritus (score 0–3). Mean (SD) value of the worst pruritus score reported on a scale of 0–10 was 4 (2.59). Only seven out of the 124 patients (5.6%) required treatment for pruritus. With respect to distress and bother from itching in the past 24 hours on a score of 0–4, the mean score reported was 1.7 (1.23). Fourteen (11.2%) patients reported vomiting, dry-retching and nausea. Six (4.8%) patients had nausea that interfered with activities of daily living. Four (3.2%) patients had clinically significant post-operative nausea and vomiting. Seven (5.6%) patients received anti-emetics. The average Overall Benefit of Analgesia Score was 3.8 (SD 2.6, min–max: 0–15). The average (SD) maternal satisfaction with pain relief and side effects was 84.9% (9.9%). Conclusion: There is a high incidence of pruritus, with most women reporting moderate to severe pruritus. The incidence of post-operative nausea and vomiting is low, and women reported good maternal satisfaction.

PREOPERATIVE ONDANSETRON VERSUS METOCLOPRAMIDE FOR PREVENTION OF NAUSEAAND VOMITING IN ELECTIVE LOWER SEGMENT CAESAREAN SECTION (LSCS) UNDER SPINALANAESTHESIA

2021 ◽  
pp. 24-25
Author(s):  
Kothari Asit ◽  
Shah Priyal ◽  
Patel Urvi
Keyword(s):  
Spinal Anaesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Lower Segment Caesarean Section ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B ◽  
Post Operative Nausea ◽  
A Prospective Study

INTRODUCTION: Post Operative Nausea and Vomiting (PONV) are the most common distressing symptom after LSCS. Antiemetic drugs play an important role to prevent it. Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved signicantly effective and hence, the present study was undertaken to compare the efcacy and safety of IVmetoclopramide and IVOndansetron as prophylaxis for postoperative nausea and vomiting in LSCS under spinal Anaesthesia OBJECTIVES: To study comparison of IV Ondansetron and IV Metoclopramide for prevention of postoperative nausea and vomiting as well as to compare any adverse effect occurrence through drugs in elective LSCS under spinal Anaesthesia. METHODS: It was a prospective study in which 100 patients were selected and randomly allotted into 2 groups, 50 patients in each group, according to inclusion criteria. Group A: Inj. Ondansetron 0.15 mg/kg i.v. Group B: Inj. Metoclopramide 0.25 mg/kg i.v. RESULT: Mean Age, Weight and Duration of surgery are comparable in both the groups without any statistical signicant difference. Incidence of nausea was 12% in group B and there was no incidence of nausea in group A in 30 min after injecting drugs. The incidence of nausea was 14% in group Aand 28% in group B in 45 min after injecting drugs. Incidence of vomiting was 16% in group B and there was no incidence of vomiting in group Ain 30 min after injecting drugs. The incidence of vomiting was 8% in group Aand 22% in group B in 45 min after injecting drugs CONCLUSION: Efcacy and safety of ondansetron is more than metoclopramide for prevention of nausea and vomiting in LSCS under spinal Anaesthesia

scholarly journals Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Antonio Moraitis ◽  
Magnus Hultin ◽  
Jakob Walldén
Keyword(s):  
Cohort Study ◽  
Spinal Anaesthesia ◽  
Postoperative Nausea ◽  
Intrathecal Morphine ◽  
Univariate Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Female Gender ◽  
Nausea And Vomiting ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Abstract Background The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis. Methods The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April–November 2013 (n = 59) and September 2014–June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV. Results Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk. Conclusions There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.

scholarly journals Dexmedetomidine, Ketamine and Lidocaine Infusion for Prevention of Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery: Randomized Trial

2021 ◽  
pp. 101-109
Author(s):  
Aya Ibrahim Moustafa ◽  
Mohamed Elsayed Afandy ◽  
Hesham Mohamed Marouf El Demairy ◽  
Hoda Alsaid Ahmed Ezz
Keyword(s):  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Morphine Consumption ◽  
Control Group ◽  
Study Group ◽  
Gynecological Surgery ◽  
Opioid Sparing ◽  
Clinically Significant ◽  
Post Operative Nausea

Background: The intraoperative use of large bolus doses or continuous infusions of potent opioids may be associated with increased analgesic consumption postoperatively. In ambulatory surgery, opioid related side effects, such as postoperative nausea and vomiting (PONV), prolonged sedation, ileus and urinary retention may delay recovery and discharge or cause unanticipated hospital readmission. The aim was to evaluate the effect of opioid sparing technique via infusion of dexmedetomidine, ketamine and lidocaine on post-operative nausea and vomiting in laparoscopic gynecological surgery. Methods: A total of 80 patients were randomly allocated into 2 groups, 40 patients each. Control group (group c) received fentanyl while, Study group (group S) received infusion of a mixture of dexmedetomidine, ketamine and lidocaine. The PONV impact scale, intraoperative consumption of isoflurane and fentanyl and post operative 24 hr. morphine consumption were measured. Results: 18 (45%) patients of control group experienced PONV versus 7 (17.5%) patients of study group and it was clinically significant. Clinically significant vomiting was observed in10 (25%) patients of control group and 1 (2.5%) patient of study group. There was a marked reduction in fentanyl, isoflurane and 24 hours’ morphine consumption in group S compared to group C.  Conclusion: Opioid sparing anesthesia with dexmedetomidine, ketamine and lidocaine infusion are superior to fentanyl for prevention of post-operative nausea and vomiting and reduction of isoflurane and, fentanyl consumption and provides better patient satisfaction in laparoscopic gynecological surgery.

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