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 Investigation of the Effects of Preoperative Hydration on the Postoperative Nausea and Vomiting

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
M. Selçuk Yavuz ◽  
Dilek Kazancı ◽  
Sema Turan ◽  
Bahar Aydınlı ◽  
Gökçe Selçuk ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Number Of Patients ◽  
Significant Difference ◽  
Intravenous Fluid Administration ◽  
Intravenous Hydration ◽  
Vas Scores ◽  
Group 2

Introduction. Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy operations still continue to be a serious problem. Intravenous fluid administration has been shown to reduce PONV. Some patients have higher risk for PONV described by APFEL score. In this study, our aim was to determine the effects of preoperative intravenous hydration on postoperative nausea and vomiting in high Apfel scored patients undergoing laparoscopic cholecystectomy surgery.Patients and Methods. This study is performed with 50 female patients who had APFEL score 3-4 after ethics committee approval and informed consent was taken from patients. The patients were divided into 2 groups: group 1 (P1): propofol + preoperative hydration and group 2 (P2): propofol + no preoperative hydration.Results. When the total nausea VAS scores of groups P1and P2to which hydration was given or not given were compared, a statistically significant difference was detected at 8th and 12th hours (P=0.001andP=0.041). It was observed that in group P1, which was given hydration, the nausea VAS score was lower. When the total number of patients who had nausea and vomiting in P1and P2, more patients suffered nausea in P2group.Discussion. Preoperative hydration may be effective in high Apfel scored patients to prevent postoperative nausea.

Addition of intrathecal atropine for prevention of postoperative nausea and vomiting in patients received intrathecal bupivacaine / morphine in lower limb surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim Abd Elghani Ramadan ◽  
Ashraf Elsayed Elagamy ◽  
Wael Sayed Ahmed Abd Elghaffar Elgharabawy ◽  
Ramez Mohamed Kamel Amin Elkady
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Postoperative Nausea ◽  
Intrathecal Morphine ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Morphine Sulphate ◽  
Hyperbaric Bupivacaine ◽  
Preservative Free

Abstract Background Intrathecal opioids administration is an attractive analgesic technique since the opioids is injected directly into the cerebrospinal fluid providing safe and effective postoperative analgesia for up to 24 hours. The most common adverse effects after intrathecal morphine are postoperative nausea, vomiting and pruritus. We evaluated the effect of intrathecal atropine on prevention of postoperative nausea and vomiting in patients receiving intrathecal hyperbaric bupivacaine and morphine in lower limb surgeries and on its effect on duration of postoperative analgesia. Methods 80 patients undergoing lower limb surgeries under spinal anesthesia were randomized into two groups. BM group Received spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine (3ml) + 200 mcg of preservative-free morphine sulphate (0.2ml) + Normal saline (0.1ml). BMA group received spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine (3ml) + 200 mcg of preservative-free morphine sulphate (0.2ml) + 100 mcg preservative-free atropine sulphate (0.1ml). Follow-up of both nausea and vomiting episodes was done during the first 24 hours postoperatively. Results Nausea and vomiting were noticed in 17 patients (42.5%) in group BM and 7 patients (17.5%) in group BMA, with significant differences (p = 0.015). As regards postoperative analgesia, there was no significant differences between BM and BMA group. Conclusions Intrathecal atropine has antiemetic effect after spinal anesthesia using bupivacaine and morphine for lower limb surgeries without affecting postoperative analgesia.

Sign in / Sign up

Export Citation Format

Share Document