Effect of single-dose intravenous dexamethasone on postoperative pain and postoperative nausea and vomiting in patients undergoing lower segment cesarean section under spinal anesthesia

Background: Lower segment caesarean sections (LSCS) are commonly done under spinal anaesthesia. Although spinal anaesthetic techniques are relatively safe and associated with quick and uneventful recovery, post-operative pain is a major concern after effect of spinal anaesthesia weans off. Other than pain postoperative nausea and vomiting (PONV) is one of the important side effects of spinal anaesthesia. Steroids by virtue of their anti-inflammatory effect is expected to reduce pain consequent upon inflammation and many studies have shown their efficacy in reducing pain as well as PONV in post-operative patients. Aims and Objectives: Primary objective of the study was to evaluate efficacy of single-dose dexamethasone in reducing post-operative pain. The secondary objectives were to analyse effect of single-dose dexamethasone on hemodynamic stability as well as incidence of nausea and vomiting in patients undergoing LSCS under spinal anesthesia. Materials and Methods: This was a double-blind comparative study in which 60 patients undergoing LSCS under spinal anaesthesia were included on the basis of a predefined inclusion and exclusion criteria. Written informed consent was obtained from all patients. The patients were divided into two groups: Group D: 30 patients who received IV dexamethasone 8 mg (2 ml) intravenously just before giving spinal anesthesia. Group N: 30 patients who received Normal saline (2 ml) immediately before spinal anesthesia. In both groups, hemodynamic parameters, respiratory rate, severity of post-operative pain, and incidence of PONV was compared. P value less than 0.05 was taken as statistically significant. Results: Patients in Group D had significantly less severe post-operative pain (as assessed by the Visual analog scale) and incidence of PONV (P<0.05). Significantly less post-operative rescue analgesia was required in patients who received single dose of intravenous dexamethasone (P<0.05). In terms of hemodynamic stability, both groups were found to be comparable with no statistically significant difference. Conclusion: Single-dose dexamethasone is effective in reducing post-operative pain as well as incidence of PONV in patients undergoing LSCS under spinal anesthesia.

Analysis the Safety and Efficacy at Different Types of Anesthesiological Support During Aesthetic Interventions on the Breast Glands in Ukraine

The aim is to learn the features of aesthetic and reduction surgical interventions on the mammary glands in Ukraine. Materials and methods. The study was conducted by analyzing the inpatient ambulatory cards of 320 patients. Anesthesia was provided by propofol (n=130), sevoflurane (n=140) and combined use of sevoflurane and nalbuphine (n=50). The results of the study. It was found that usage of combined inhalation analgesia of sevoflurane with opioids was characterized by 41.9% less recovery time. It was found that 8 hours after surgery, the individual assessment of pain was lower in the group of combined analgesia with opioids relative to intravenous anesthesia with propofol (87.5%, p<0.05) and inhalation anesthesia with sevoflurane (71, 3%, p<0.05). After 24 hours all patients reported about pain below 1.0 point, however, in groups where sevoflurane and nalbuphine were used, the level of pain self-esteem was 2.61 and 3 times lower than after intravenous propofol. It was found that within 1 hour after surgery, the average cognitive score on the Montreal scale decreased in the group of intravenous propofol by 5.0% (p<0.05) and by 1.7% under inhalation anesthesia with sevoflurane. Under combined anesthesia the cognitive score remained at 12.0 points. The frequency of postoperative nausea was the highest level in the group of inhalation anesthesia - 16.7%. The addition of nalbuphine to sevoflurane significantly reduced the risk of postoperative nausea (χ2=7.250; p=0.007). Conclusions. Combined anesthesia with opioids is a highly effective anesthetic choice for aesthetic and reconstructive interventions on the mammary glands.

Low incidence of postoperative nausea, vomiting, regurgitation, and aspiration pneumonia in geriatric dogs receiving maropitant, famotidine, and fentanyl as part of an anesthesia protocol

OBJECTIVE To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol. ANIMALS 105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between January 2019 and March 2020. PROCEDURES Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes. RESULTS 2 of 105 (1.9%) dogs regurgitated, 1 of 105 (1.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (≥ 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (≥ 4) for both regurgitation and aspiration pneumonia. CONCLUSIONS AND CLINICAL RELEVANCE The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks.

Complementary Intervention in Postoperative Care: Aromatherapy's Role in Decreasing Postoperative Nausea and Vomiting

Purpose: This study analyzed the efficacy of Post-Ease, a custom essential oil aromatherapy blend, in decreasing postoperative nausea and vomiting (PONV) and the need for antiemetic drugs in an orthopaedic surgical population. Study Design: This is retrospective cohort study, utilizing electronic health record data pre- and post-implementation of a nurse-driven quality improvement intervention. Methods: The study examined the impact of an inhaled custom blend of essential oils containing lavender, peppermint, ginger and lemon to assist in decreasing PONV and reduce the use of antiemetic medications. Data on the use of antiemetic drugs in pre- and post-intervention periods were analyzed. Findings: Nurses provided the Post-Ease blend 384 times in 2020 to patients as an option before proceeding, if necessary, to antiemetic drugs. The intervention group demonstrated a statistically significant reduction in the number of unique surgical patients’ need for antiemetics as treatment (22%; p = .05). Similarly, the total doses of antiemetics administered was significantly reduced (21%; p ≤ .05) during the study period. Conclusion: This study supports the use of aromatherapy to reduce PONV and minimize antiemetic use in an orthopaedic population.

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

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.

Effects of Dexmedetomidine on Postoperative Nausea and Vomiting in Adult Patients Undergoing Ambulatory Thyroidectomy: A Randomized Clinical Trial

Background: Postoperative nausea and vomiting (PONV) is a common and disturbing problem in patients undergoing ambulatory thyroidectomy. This prospective trial aimed to explore whether dexmedetomidine (DEX) combined with azasetron (AZA) can further drop the incidence of PONV in patients undergoing ambulatory thyroidectomy compared with AZA.Methods: This single-center, randomized, double-blind trial involved 172 adult patients undergoing ambulatory thyroidectomy. The individuals were randomized to DEX + AZA group and AZA group. In the DEX + AZA group, patients received dexmedetomidine 0.5 μg kg−1 for 10 min and then the infusion rate was held at 0.1 μg kg−1 h−1 until the completion of the operation, while the same amount of 0.9% saline in the AZA group. At the completion of the surgery, 10 mg azasetron was administered to every patient in both groups. The primary outcome was the incidence of 24 h PONV after ambulatory thyroidectomy. The secondary outcomes included residence time in recovery room, pain scores, severity of nausea, and adverse events.Results: No significant difference was found in the incidence of 24-h PONV between the DEX + AZA group and the AZA group [36% (30 of 84) vs. 38% (32 of 84); relative risk, 0.94; 95% confidence interval (CI), 0.63–1.40; P = 0.749]. The incidence of severe nausea was similar between the DEX + AZA group and the AZA group [57% (12 of 21) vs. 43% (9 of 21); relative risk, 1.33; 95% CI, 0.72–2.50; P = 0.355].Conclusions: Intraoperative dexmedetomidine combined with azasetron failed to drop the incidence of 24-h PONV compared with azasetron alone in patients undergoing ambulatory thyroidectomy.

Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial

Background Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. Objectives This study aims to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. Methods A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing versus no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. Results The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the two groups diminished by POD 2. Patients having received throat packs also demonstrated a higher usage of opioids in post anesthesia care unit (PACU). The incidence of PONV was not significantly different between the two cohorts at any point of observations. Conclusions This study demonstrates results that largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering this data, we do not recommend routine use of throat packing during elective septorhinoplasty.