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Thiel B, Blaauboer J, Seesing C, Radmanesh J, Koopman S, Kalkman C, Godfried M. Patient self-reported pain and nausea via smartphone following day care surgery, first year results: An observational cohort study. PLOS DIGITAL HEALTH 2024; 3:e0000342. [PMID: 38985704 PMCID: PMC11236166 DOI: 10.1371/journal.pdig.0000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/22/2024] [Indexed: 07/12/2024]
Abstract
Contact with the hospital is usually limited for patients after day care surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients' self-reported pain and nausea and assess the success of routine implementation of a smartphone application for outcome reporting. During preoperative assessment, patients were instructed to download and activate the smartphone application to report pain, nausea and to be in contact with the hospital after discharge. Main outcome was the number of patients actively using the smartphone application and the incidence of pain and nausea on postoperative day 1 to 7. In total, 4952 patients were included in the study. A total of 592 (12%) participants downloaded the application, of whom 351 (7%) were active users. A total of 4360 (88%) participants refrained from downloading the application. 56% (2,769) were female, the median age was 46 (18-92), and 4286 (87%) were classified as 1 or 2 American Society of Anesthesiologists Physical Status (ASA). Postoperative pain was experienced by 174 (76%) of 229 active users on postoperative day (POD) 1 and decreased to 44 (44%) of 100 active users on POD7. Postoperative nausea was experienced by 63 (28%) of 229 active users on POD1 and decreased to 12 (12%) of 100 active users on POD7. Female sex (p .000), socioeconomic status (p .001), and surgical severity (p .001) showed statistically significant differences between active users, non-active users, and non-downloaders. Most patients active with the application experienced pain and nausea on the first and second day after discharge. Only a minority of the patients used the application. Those who used it were satisfied with the possibilities offered to them. Future research should focus on increasing the uptake and effect of this application on the quality of recovery.
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Affiliation(s)
- Bram Thiel
- Department of anaesthesia, OLVG Hospital, Amsterdam, the Netherlands
| | - Jamey Blaauboer
- Faculty of medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Chiem Seesing
- Faculty of medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Jamshid Radmanesh
- Department of information technology, OLVG Hospital, Amsterdam, the Netherlands
| | - Seppe Koopman
- Department of anaesthesia, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cor Kalkman
- Department of anaesthesia, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marc Godfried
- Department of anaesthesia, OLVG Hospital, Amsterdam, the Netherlands
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Moraitis A, Myrberg T, Hultin M, Nyström H, Walldén J. Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. Br J Anaesth 2023:S0007-0912(23)00227-1. [PMID: 37246062 DOI: 10.1016/j.bja.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients. METHODS In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionnaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3. RESULTS The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700). CONCLUSIONS Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation. CLINICAL TRIAL REGISTRATION EudraCT 2015-003956-32.
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Affiliation(s)
- Antonio Moraitis
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences (Sunderbyn), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Helena Nyström
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden
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Intraoperative Hypotension Is Associated with Postoperative Nausea and Vomiting in the PACU: A Retrospective Database Analysis. J Clin Med 2023; 12:jcm12052009. [PMID: 36902796 PMCID: PMC10004657 DOI: 10.3390/jcm12052009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Multiple risk factors for postoperative nausea and vomiting (PONV)-a very distressing and outcome-related complication-have been identified, including female sex, absence of a history of smoking, history of PONV, and postoperative opioid use. Evidence of association of intraoperative hypotension with PONV is contradictory. A retrospective analysis of the perioperative documentation of 38,577 surgeries was conducted. The associations between different characterizations of intraoperative hypotension and PONV in the postoperative care unit (PACU) were investigated. First, the relationship between different characterizations of intraoperative hypotension with regard to PONV in the PACU was investigated. Secondly, the performance of the optimal characterization was assessed in an independent dataset derived via random split. The vast majority of characterizations showed an association of hypotension with the incidence of PONV in the PACU. In a multivariable regression, time with a MAP under 50 mmHg showed the strongest association with PONV in terms of the cross-validated Brier score. The adjusted odds for PONV in the PACU were estimated to be 1.34 times higher (95% CI: 1.33-1.35) when a MAP was under 50 mmHg for at least 1.8 min than when a MAP remained above 50 mmHg. The finding indicates that intraoperative hypotension may yet be another risk factor for PONV and therefore emphasizes the importance of intraoperative blood pressure management not only in patients at risk for cardiovascular complications but also in young and healthy patients at risk of PONV.
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Thiel B, Godfried MB, van Emst ME, Vernooij LM, van Vliet LM, Rumke E, van Dongen RTM, Gerrits W, Koopman JSHA, Kalkman CJ. Quality of recovery after day care surgery with app-controlled remote monitoring: study protocol for a randomized controlled trial. Trials 2023; 24:102. [PMID: 36759858 PMCID: PMC9909143 DOI: 10.1186/s13063-023-07121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient's recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient's recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring. METHODS This non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery. The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions. The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery. DISCUSSION This study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period. TRIAL REGISTRATION The 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial' is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial', is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772).
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Affiliation(s)
- B. Thiel
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. B. Godfried
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. E. van Emst
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - L. M. Vernooij
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
| | - L. M. van Vliet
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - E. Rumke
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - R. T. M. van Dongen
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - W. Gerrits
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - J. S. H. A. Koopman
- Department of Anaesthesiology, Maasstad Ziekenhuis, Maasstadweg 21, Rotterdam, 3079 DZ The Netherlands
| | - C. J. Kalkman
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
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Stjernberg M, Schlichting E, Rustoen T, Valeberg BT, Småstuen M, Raeder JC. Postdischarge pain, nausea and patient satisfaction after diagnostic and breast-conserving ambulatory surgery for breast cancer: A cross-sectional study. Acta Anaesthesiol Scand 2022; 66:317-325. [PMID: 34888855 DOI: 10.1111/aas.14015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Mi Stjernberg
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Ellen Schlichting
- Department of Breast and Endocrine Surgery Oslo University Hospital Oslo Norway
| | - Tone Rustoen
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Berit T. Valeberg
- Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Milada C. Småstuen
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Johan C. Raeder
- Faculty of Medicine University of Oslo Oslo Norway
- Division of Emergencies and Critical Care Department of Anaesthesiology Oslo University Hospital Oslo Norway
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Johansson E, Hultin M, Myrberg T, Walldén J. Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients. Acta Anaesthesiol Scand 2021; 65:1229-1239. [PMID: 34086350 DOI: 10.1111/aas.13936] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%-40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV. METHODS This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4 hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV. RESULTS A total of 2030 patients were included in the study, of which 9.6% (n = 194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35 kg m-2 and major surgery and anaesthesia time ≥60 minutes. CONCLUSION We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.
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Affiliation(s)
- Emma Johansson
- Department of Surgical and Perioperative Sciences Anaesthesiology and Intensive Care Medicine (Sundsvall) Umeå University Umeå Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences Anaesthesiology and Intensive Care Medicine (Umeå) Umeå University Umeå Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences Anaesthesiology and Intensive Care Medicine (Sunderbyn) Umeå University Umeå Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences Anaesthesiology and Intensive Care Medicine (Sundsvall) Umeå University Umeå Sweden
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Maraş G, Bulut H. Prevalence of Nausea-Vomiting and Coping Strategies in Patients Undergoing Outpatient Surgery. J Perianesth Nurs 2021; 36:487-491. [PMID: 34167895 DOI: 10.1016/j.jopan.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aimed to determine the prevalence and coping strategies for postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) in patients undergoing outpatient surgery. DESIGN A descriptive research design was used. METHODS This descriptive study was carried out with 350 patients who were admitted within the scope of outpatient surgery of the ear, nose, and throat; orthopaedics, urology, and general surgery departments of a university hospital between July 3, 2017 and March 6, 2018. A patient diagnosis form consisting of 34 items developed by the researcher and nausea-vomiting diary were used to collect data. FINDINGS The results showed that 30.6% of the patients had PONV and 26.3% had PDNV. Of the 92 patients with postdischarge nausea, 26.1% experienced mild, 44.6% moderate, 20.7% high, and 8.7% severe nausea. Among the strategies for coping with PDNV, the patients preferred resting (49%), going outdoors (23.4%), eating something (17%), and drinking something (10.6%). A statistically significant difference was found between postdischarge nausea and risk factors for nausea-vomiting, such as female gender, history of nausea-vomiting, nausea in the postanesthesia care unit, and opioid use in the postanesthesia care unit (P < .05). CONCLUSIONS This study shows that approximately a quarter of patients who undergo outpatient surgery will experience nausea and vomiting immediately after surgery as well as at home after discharge. Assessment of risk factors for PONV/PDNV was discovered to be an important factor in the care of perioperative patients. Therefore, the risk scoring system is expected to contribute to reducing PONV/PDNV incidence and improving patient coping strategies and satisfaction.
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Affiliation(s)
- Gülseren Maraş
- Department of Surgical Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Hülya Bulut
- Department of Surgical Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
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Grass N, Bundy E. Postdischarge Nausea and Vomiting Risk Assessment in Breast and Gynecologic Surgical Patients. J Perianesth Nurs 2021; 36:339-344. [PMID: 33653617 DOI: 10.1016/j.jopan.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Postdischarge nausea, vomiting, and retching often occur after the time of discharge from the postanesthesia care unit (PACU) in patients who have undergone outpatient surgeries. At a large mid-Atlantic Academic Hospital, 40% of gynecologic outpatient surgical patients had postdischarge nausea and vomiting (PDNV). The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool to improve PDNV risk screening in the PACU. DESIGN This quality improvement project was part of an evidence-based practice project. METHODS After identification and recruitment of key stakeholders and unit champions, a force-field analysis, as part of Lewin's change theory, was completed to identify the driving and restraining forces. All PACU registered nurses received education on the risk assessment protocol using the Apfel risk assessment tool. The Apfel risk assessment tool has been validated to identify five independent risk factors for PDNV in outpatient ambulatory surgical populations. Implementation of the tool with data collection occurred for 8 weeks on all scheduled outpatient breast and gynecologic surgical patients. Staff compliance was measured throughout implementation. FINDINGS In patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients, respectively. Compliance with the tool was high with an average compliance rate of 92% for the 8-week data collection period. CONCLUSIONS Data analysis demonstrated that the Apfel risk assessment tool adequately predicted the risk for PDNV in outpatient surgical breast and gynecologic patients. Use of Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. In addition, this quality improvement project resulted in increased compliance of the standing follow-up phone call policy. Efforts toward sustainment include expansion to all outpatient surgical populations and implementation of a PDNV prevention and management guideline.
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Affiliation(s)
- Nicole Grass
- Nurse Anesthesia Practice Program, Georgetown University, Washington, DC.
| | - Elaine Bundy
- Nurse Practitioner program, University of Maryland School of Nursing, Baltimore, MD
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Dziadzko M, Aubrun F. Management of postdischarge nausea and vomiting. Best Pract Res Clin Anaesthesiol 2020; 34:771-778. [PMID: 33288126 DOI: 10.1016/j.bpa.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Postdischarge nausea and vomiting (PDNV) occurs in at least 30% of patients leaving hospital, especially after day-case surgery. A significant number of ambulatory patients may develop PDNV associated with the use of analgesics for postsurgical pain. A validated PDNV prediction score and international evidence-based consensus guidelines for PONV/PDNV management are available. High-risk patients benefit from a predischarge PDNV risk assessment and the use of adapted pharmacological intervention (combination of long- and short-acting antiemetics and access to antiemetics at home). Patient education is often overlooked in this context. All clinicians involved in the ambulatory surgery care process should participate in the development of institutional protocol for PONV/PDNV management. Constant quality control and patients' feedback should be integrated as part of an efficient implementation strategy.
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Affiliation(s)
- Mikhail Dziadzko
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
| | - Frédéric Aubrun
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
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10
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Moraitis A, Hultin M, Walldén J. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiol 2020; 20:242. [PMID: 32972366 PMCID: PMC7517815 DOI: 10.1186/s12871-020-01154-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Antonio Moraitis
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Sundsvall, Sweden.
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Sundsvall, Sweden
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Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9. [PMID: 32913634 PMCID: PMC7429924 DOI: 10.12688/f1000research.21832.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.,Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA
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Transforming Perianesthesia Clinical Practice Through Dissemination and Implementation Science. J Perianesth Nurs 2018; 33:1014-1016. [PMID: 30449431 DOI: 10.1016/j.jopan.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022]
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Predictive risk scores for post-discharge nausea and vomiting: Simple lessons learned for improving clinical practice. Eur J Anaesthesiol 2018; 33:705-7. [PMID: 27585074 DOI: 10.1097/eja.0000000000000515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Halliday TA, Sundqvist J, Hultin M, Walldén J. Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand 2017; 61:471-479. [PMID: 28374473 DOI: 10.1111/aas.12884] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The risk of post-operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis. METHODS This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval. RESULTS Sixty five per cent (54-75) of the patients experienced PONV in the first 24 post-operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66-87) of women and 26% (12-49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra-optimal prophylaxis. The risk of PONV was 82% (59-94) with optimal prophylaxis and 59% (46-71) with supra-optimal prophylaxis. Of all patients, 34% (24-45) experienced severe PONV in the first 24 h that limited their activity. CONCLUSIONS The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.
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Affiliation(s)
- T. A. Halliday
- Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sundsvall Umeå University Sundsvall Sweden
| | - J. Sundqvist
- Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sundsvall Umeå University Sundsvall Sweden
| | - M. Hultin
- Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sunderbyn Umeå University Luleå Sweden
| | - J. Walldén
- Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sundsvall Umeå University Sundsvall Sweden
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