Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens

Abstract BACKGROUND: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. METHODS: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. RESULTS: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. CONCLUSION: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. TRIAL REGISTRATION: ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery. KEYWORDS: enhanced recovery after surgery (ERAS), postoperative nausea and vomiting (PONV), infratentorial craniotomy, anxiety, sleep quality.

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Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/57 ◽

2020 ◽

Vol 1;23 (1;1) ◽

pp. 57-64 ◽

Cited By ~ 2

Author(s):

Joseph H. Marcotte

Keyword(s):

Pain Management ◽

Colorectal Surgery ◽

Postoperative Nausea ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Postoperative Nausea And Vomiting ◽

Opioid Use ◽

Patient Controlled Analgesia ◽

Pain Scores ◽

Eras Protocol

Background: Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications. Objectives: To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery. Study Design: This was a retrospective observational study. Setting: This research took place within an established perioperative colorectal surgery protocol. Methods: A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups. Results: There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449). Limitations: Significant limitations include the studies’ retrospective nature and that it was performed at a single institution. Conclusions: Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting. Key words: Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid

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Pengaruh Pemberian Minuman Karbohidrat (Maltodekstrin 12,5%) Praoperasi terhadap Kejadian Mual dan Muntah Pascamastektomi

Jurnal Anestesi Perioperatif ◽

10.15851/jap.v8n2.2039 ◽

2020 ◽

Vol 8 (2) ◽

pp. 67-74

Author(s):

Andre Aditya ◽

Iwan Fuadi ◽

Iwan Abdul Rachman

Keyword(s):

Postoperative Nausea ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Mineral N

Mual dan muntah pascaoperasi (postoperative nausea and vomiting, PONV) menjadi masalah yang umum terjadi setelah operasi mastektomi dengan angka kejadian berkisar 21–92%. Pemberian minuman karbohidrat (CHO) praoperasi ditawarkan sebagai sebuah solusi menurunkan PONV dan juga merupakan salah satu komponen penting dan disarankan untuk mencapai enhanced recovery after surgery (ERAS). CHO berhubungan dengan penurunan katabolisme dan resistensi insulin pascaoperasi. Penelitian ini bertujuan mengetahui pengaruh pemberian minuman berkarbohidrat (CHO) oral sebelum operasi terhadap tingkat kejadian PONV pascaoperasi mastektomi. Penelitian menggunakan eksperimental uji acak buta tunggal di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada November 2019–Februari 2020. Sebanyak 46 pasien dibagi menjadi dua kelompok, yakni kelompok K (kelompok kontrol, air mineral, n=23 subjek) dan kelompok C (kelompok CHO, n=23 subjek). Analisis data hasil penelitian dilakukan dengan Uji Mann-hitney. Kejadian mual muntah pada kelompok kontrol lebih besar dibanding dengan kelompok CHO pada menit 0–30 (57% vs 22%), pada menit 30–60 (91% vs 61%), dan pada menit 60–120 (78% vs 61%) dengan perbedaan yang bermakna (p<0,05). Simpulan, pemberian minuman karbohidrat praoperasi dapat menurunkan kejadian mual muntah pascamastektomi dibandingkan dengan kelompok kontrol.

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Enhanced Recovery after Surgery (ERAS) Protocol Is a Safe and Effective Approach in Patients with Gastrointestinal Fistulas Undergoing Reconstruction: Results from a Prospective Study

Nutrients ◽

10.3390/nu13061953 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1953

Author(s):

Stanislaw Klek ◽

Jerzy Salowka ◽

Ryszard Choruz ◽

Tomasz Cegielny ◽

Joanna Welanyk ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Postoperative Nausea ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Consecutive Series ◽

Eras Protocol

Background and Aims: An enterocutaneous fistula (ECF) poses a major surgical problem. The definitive surgical repair of persistent fistulas remains a surgical challenge with a high rate of re-fistulation and mortality, and the reasons for that is not the surgical technique alone. Enhanced Recovery after Surgery (ERAS®) is an evidence-based multimodal perioperative protocol proven to reduce postoperative complications. The aim of the study was to assess the clinical value of the ERAS protocol in surgical patients with ECF. Methods: ERAS protocol was used in all patients scheduled for surgery for ECF at the Stanley Dudrick’s Memorial Hospital in Skawina between 2011 and 2020. A multidisciplinary team (MDT) was in charge of the program and performed annual audits. A consecutive series of 100 ECF patients (44 females, 56 males, mean age 54.1 years) were evaluated. Postoperative complications rate, readmission rate, length of hospital stay, prevalence of postoperative nausea and vomiting were assessed. Registered under ClinicalTrials.gov Identifier no. NCT04771832. Results: ERAS protocol was successfully introduced for ECF surgeries; however, eight modifications to the ERAS program was performed in 2015. They led to improvement of surgical outcomes: reduction of postoperative nausea and vomiting (15 vs. 17% patients, p = 0.025), overall complication rate (11 vs. 10, p = 0.021), median length of hospital stay (overall and after surgery, p = 0.022 and 0.002, respectively). Conclusions: ERAS protocol can be successfully used for ECF patients. Prescheduled audits can contribute to the improvement of care.

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Erratum to: ‘Prophylaxis and management of postoperative nausea and vomiting in enhanced recovery protocols’

Perioperative Medicine ◽

10.1186/s13741-016-0034-3 ◽

2016 ◽

Vol 5 (1) ◽

Author(s):

Ruchir Gupta ◽

Roy Soto

Keyword(s):

Postoperative Nausea ◽

Enhanced Recovery ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Recovery Protocols

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Successful implementation of an Enhanced Recovery After Surgery (ERAS) protocol reduces nausea and vomiting in patients after infratentorial craniotomy: a randomized controlled trial

10.21203/rs.2.15916/v1 ◽

2019 ◽

Author(s):

Dan Lu ◽

Yuan Wang ◽

Tianzhi Zhao ◽

Bolin Liu ◽

Lin Ye ◽

...

Keyword(s):

Sleep Quality ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Anxiety Level ◽

Nausea And Vomiting ◽

Control Group ◽

Successful Implementation ◽

Eras Protocol

Abstract Objectives: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV.Methods: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications.Results: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group.Conclusion: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications.

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Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676477 ◽

2019 ◽

Vol 32 (02) ◽

pp. 121-128 ◽

Cited By ~ 18

Author(s):

J. Simpson ◽

Xiaodong Bao ◽

Aalok Agarwala

Keyword(s):

Colorectal Surgery ◽

Pain Control ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Postoperative Nausea And Vomiting ◽

Bowel Function ◽

Opioid Therapy ◽

Opioid Use ◽

Early Return ◽

Eras Protocol

AbstractPain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.

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