Measurement of Postdischarge Nausea and Vomiting for Ambulatory Surgery Patients: A Critical Review and Analysis

Postdischarge pain, nausea and patient satisfaction after diagnostic and breast-conserving ambulatory surgery for breast cancer: A cross-sectional study

BACKGROUND

The aims of this study were to assess first day postdischarge pain, nausea and patient satisfaction in ambulatory breast cancer surgical patients, after diagnostic and breast conserving procedures.

METHODS

A total of 781 women, aged 18-85 years were included in this prospective, cross-sectional study. All patients received standardized multimodal pain prophylaxis with paracetamol, COX-II inhibitor, dexamethasone and wound infiltration with local anaesthetics. Nausea prophylaxis was provided with ondansetron. Most patients received general anaesthesia with propofol and remifentanil. Data were collected using a validated questionnaire during telephone follow-up on the first postoperative day.

RESULTS

The response rate was 94.5%. NRS ≥ 4 was reported by 5.3% at rest, by 17% during activity and by 30.7% as the worst pain score. Young age was strongly associated with more pain both at rest, during activity and regarding worst pain since discharge. Postdischarge nausea was present in 17.8%, and vomiting in 1.2%. High pain score during activity and higher level of worst pain, were associated with nausea. There was no association between nausea and age, type of anaesthesia, surgical procedure or pain at rest. Patient satisfaction was high (97.8%-99.7%) regarding information, time for discharge and overall satisfaction.

CONCLUSION

Pain scores and incidence of nausea were generally low on the day after surgery. Young age was a strong predictor for postdischarge pain. A high worst pain score and high pain score during the activity were associated with postdischarge nausea. Patient satisfaction was high.

Postoperative Nausea and Vomiting in Pediatric Patients

Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.

A Quality Improvement Project to Determine the Effect of Aromatherapy on Postoperative Nausea and Vomiting in a Short-Stay Surgical Population

Postoperative nausea and vomiting (PONV) is a major concern for short-stay surgical patients because it can delay discharge and cause preventable postoperative complications, which in turn can increase hospital costs. Evidence suggests that aromatherapy effectively reduces PONV, either as a monotherapy or in conjunction with pharmacologic antiemetics. This quality improvement project investigated the effectiveness of aromatherapy in reducing PONV in a short-stay surgical population. The outcome of this project supported the hypothesis that the administration of blended aromatherapy would result in a significant decrease in patients' self-reported ratings of nausea. This finding suggests that aromatherapy is an appropriate adjunct therapy for decreasing patient nausea and vomiting in this short-stay surgical unit and may help prevent discharge delays in this population.

Psychometric Properties of the Ambulatory Surgery Index of Nausea, Vomiting, and Retching

BACKGROUND AND PURPOSE

At least one-third of ambulatory surgery patients will experience nausea or vomiting during the recovery period. The purpose of this study was to examine the psychometric properties of the Ambulatory Surgery Index of Nausea, Vomiting, and Retching (AS-INVR).

METHODS

Secondary analysis of longitudinal data from a study of 203 adult ambulatory surgery patients was conducted.

RESULTS

Based on the results of factor analysis, the retching item was eliminated and the 6-item, 2-dimensional AS-INV was formed. Cronbach's alphas for the AS-INV ranged from .83 to .87 across the 5 days postsurgery. Higher AS-INV scores were associated with self-reported presence of nausea and lower quality of life.

CONCLUSIONS

The shortened AS-INV provides a reliable and valid measure of the amount and distress because of nausea and vomiting in adult patients after ambulatory surgery and should be considered for use in future studies.

Postdischarge nausea and vomiting: management strategies and outcomes over 7 days

PURPOSE

The purpose of this study is to determine patient management strategies and outcomes for self-care of postdischarge nausea and vomiting (PDNV).

DESIGN

Prospective, comparative, descriptive, and longitudinal study.

METHODS

The sample consisted of 248 patients aged 18 years or older undergoing a procedure requiring general anesthesia. Patients recorded incidence and severity of nausea and vomiting, the impact of symptoms, and actions taken to alleviate symptoms for 7 days postdischarge.

FINDINGS

The prevalence of PDNV was 56.9%. The methods used to relieve symptoms included antiemetic use by a minority and nonpharmacologic techniques of self-management by some. The effect of nausea on QOL, patient functioning, and patient satisfaction was significantly worse for those who experienced postdischarge nausea on all days.

CONCLUSION

Patients with PDNV use minor self-care strategies to manage symptoms. The presence of PDNV affects overall quality of life, patient functioning, and patient satisfaction.

Preventing postoperative nausea and vomiting: refresh your knowledge of how to recognize and respond to this common complication

For surgical patients, postoperative nausea and vomiting (PONV) is one of the most undesired complications of anesthesia and surgery.