Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk population

Postoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients. We randomized 77 subjects scheduled for general anesthesia and screened for 4 of 5 PONV risk factors for experimental or control group assignment. Severity of PONV was measured using a 0 to 10 verbal numeric rating scale (VNRS). Other measured variables included time to onset and incidence of PONV and total antiemetic requirements. No significant differences in demographics (excluding weight), surgical or anesthesia time, analgesic requirements, or nausea incidence in the postanesthesia care unit (PACU) and same-day surgery unit were noted. The meclizine group had lower VNRS scores in the PACU at 15 (P = .013) and 45 (P = .006) minutes following rescue treatment. The incidence of nausea was lower in the meclizine vs. placebo group (10% vs. 29%) following discharge (P = .038). Prophylactic meclizine resulted in lower incidence and severity of PONV in a high-risk population, especially after rescue treatment.     

A randomized controlled trial of two different interventions for the prevention of postoperative nausea and vomiting: total intravenous anaesthesia using propofol and remifentanil versus prophylactic palonosetron with inhalational anaesthesia using sevoflurane-nitrous oxide

Total intravenous anaesthesia (TIVA) can reduce the risk of postoperative nausea and vomiting (PONV) almost as much as a single antiemetic. This study compared TIVA (using propofol and remifentanil) with prophylactic palonosetron (a 5-hydroxytryptamine type 3 receptor antagonist) combined with inhalation anaesthesia using sevoflurane in 50% nitrous oxide, for the prevention of PONV. Patients were randomly assigned to one of two prophylactic interventions: (i) palonosetron 0.075 mg, intravenously before induction of inhalation anaesthesia (palonosetron group); and (ii) TIVA (propofol target blood concentration 2.5-6.0 μg/ml; remifentanil target blood concentration 2.5-6.0 ng/ml; TIVA group). Nausea/vomiting occurrence and severity were monitored immediately after the end of surgery for 24 h. The incidence of PONV was around 50% in both groups and the severity of nausea was similar in both groups. Prophylactic palonosetron with inhalational anaesthesia using sevoflurane in 50% nitrous oxide reduced the incidence of PONV after gynaecological laparoscopic surgery almost as much as TIVA using propofol and remifentanil.     

氟比洛芬酯联合地塞米松对甲状腺术后疼痛和恶心、呕吐的治疗作用

目的观察氟比洛芬酯复合地塞米松对甲状腺手术后疼痛和恶心、呕吐的治疗作用。方法100例ASA为Ⅰ～Ⅱ级甲状腺手术病人分为5组,每组20例,各组病人在麻醉诱导后手术开始前15min分别静脉注射生理盐水5mL,氟比洛芬酯50mg,地塞米松5mg和氟比洛芬酯50mg,地塞米松10mg和氟比洛芬酯50mg,地塞米松15mg和氟比洛芬酯50mg。手术结束后2、4、8、12、24和48h应用视觉模拟（VAS）评分法评估切口疼痛程度,观察术后恶心、呕吐的发生率。结果术后2h各组的VAS评分没有明显差别（P〉0．05）,术后4、8、12、24hⅡ组的VAS评分低于Ⅰ组,Ⅲ组低于Ⅱ组,但无统计学意义（P〉0．05）;Ⅲ组低于Ⅰ组（P〈0．05）,Ⅳ和Ⅴ组VAS均明显低于Ⅰ组、Ⅱ组（P〈0．01）和Ⅲ组（P〈0．05）,术后48h各组的VAS评分无明显区别（P〉0．05）。术后0～2h内各组均无恶心、呕吐发生,2～48h内各组发生恶心、呕吐的例数分别为9、8、3、2、3,应用地塞米松组恶心、呕吐明显低于未用地塞米松组（P〈0．05）。结论甲状腺手术开始前给予氟比洛芬酯50mg和地塞米松10mg,可以获得术后较好的镇痛、止吐效果。     

Influence of postoperative pain therapy on nausea and vomiting

PROBLEM: Postoperative nausea and vomiting remains an important problem. Many risk factors have been identified; however, the importance of postoperative analgesic technique and patient expectation remain poorly defined. METHODS: We prospectively collected data on postoperative nausea and vomiting (PONV) in four groups of randomly selected patients (n=50 per group) who received either simple analgesics, nurse-administered intravenous morphine (NAA), patient-controlled analgesia (PCA) with morphine or epidural analgesia with bupivacaine and fentanyl. Patients were questioned regarding any past history of PONV or motion sickness, their preoperative expectation of suffering PONV and satisfaction with their antiemetic therapy. RESULTS: The incidence of nausea was higher in both morphine groups P<0.05), women (P<0.05), those less than the median age of their group (P<0.05) and those with a past history of PONV (P<0.05) or motion sickness (P<0.05). Most patients did not expect to experience PONV (19.3%). The incidence of nausea was higher in those expecting to experience PONV than in those not expecting to suffer PONV (P<0.01). Of those who received postoperative antiemetic treatment, 23.6% were dissatisfied or very dissatisfied with their therapy. Few patients received a prophylactic antiemetic drug (15%). CONCLUSIONS: Study results show that patient expectation is a potent predictor of postoperative nausea, a risk factor hitherto ignored in the anaesthetic literature, and that, in the provision of analgesia following major surgery, epidural analgesia is associated with less PONV than intravenous morphine.     

A randomized double blind study to evaluate efficacy of palonosetron with dexamethasone versus palonosetron alone for prevention of postoperative and postdischarge nausea and vomiting in subjects undergoing laparoscopic surgeries with high emetogenic risk

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common occurrences (50%-80%) after laparoscopic surgery. Palonosetron (Pal), the newest 5-HT3 antagonist, is an effective antiemetic that has advantages in treating PDNV due to its prolonged duration of action. We hypothesized that a combination of Pal and dexamethazone (Dex) could further improve the efficacy of the treatment in comparison to Pal alone in patients at high risk for PONV. Patients scheduled to undergo laparoscopic surgeries under general anesthesia were randomized to receive 8-mg dexamethasone + 0.075-mg palonosetron (Pal + Dex) or an equivalent volume of saline + 0.075 mg palonosetron (Pal). Data was collected at defined postoperative times (2, 6, 12, 24, and 72 hours). All patients also completed an 18-question QOL-Functional Living Index-Emesis instrument at 96 hours. We enrolled 118 patients, ASA 1-2, with at least 3 PONV risk factors, who were undergoing outpatient surgery. Both groups had a low incidence of vomiting in the PACU (Pal + Dex, 1.7%; Pal, 6.8%) and at 72 hours (0.0% both groups). Complete response (no vomiting, no rescue medication) was not different between treatment groups for any time intervals. Cumulative success rates over the entire 72 hours were 60.4% (Pal + Dex) versus 60.0% (Pal). The Pal + Dex group showed a trend toward greater satisfaction on the QOL- Functional Living Index-Emesis scores with the greatest differences in the "nausea domain". The combination therapy of palonosetron + dexamethasone did not reduce the incidence of PONV or PDNV when compared with palonosetron alone. There was no change in comparative efficacy over 72 hours, most likely due to the low incidence of PDNV in both groups.     

Acupuncture in anesthesia or analgesic-induced nausea and vomiting

The most common and distressing symptoms following anesthesia and surgery are pain and emetic problems. Under most circumstances, pain causes the greater amount of suffering, particularly after major surgery, but in some instances postoperative nausea and vomiting (PONV) may be more distressing, particularly after minor surgery. In outpatient surgery, emesis may also have important economic implications, for example, admission to hospital beds because of intractable vomiting. Antimetic drugs given during the perioperative period may be associated with unwanted side effects, including sedation, hypotension and extrapyramidal reactions. Since 1986 there have been studies reporting beneficial antiemetic effects for Pe 6 stimulation on the right or both forearms in adults using either needling (acupuncture) or pressure (acupressure). The majority of these studies have investigated postoperative nausea and vomiting. But Pe 6 stimulation has also been shown to be an effective antiemetic for symptoms associated with pregnancy and chemotherapy. Although Pe 6 electro-acupuncture and acupressure are recognized as having an antiemetic effect, its inconvenient instrumentation may limit its clinical applicability. There have also been studies reporting beneficial antiemetic effects of P 6 acupoint injection with 50% glucose and acupuncture of the ear.     

Prevention of postoperative nausea and vomiting with highly selective 5-HT3 serotonin receptors antagonists during different types of surgery

A prospective study was conducted to examine the efficacy of highly selective, 5-HT3 serotonin receptor antagonists (Zofran, 4 mg; Latran, 4 and 8 mg; Navoban, 2 and 5 mg) during plastic and abdominal (endoscopic and routine) interventions in 165 patients aged 14 to 77 years who had ASA Classes I-III. The drugs caused no adverse reactions and were effective in controlling postoperative nausea and vomiting (PONV) after surgery under total intravenous anesthesia. In plastic surgery, Navoban, Zofran, and Latran controlled PONV in 94, 81, and 70% of cases, respectively. In abdominal surgery, Zofran (4 mg) and Latran (4 mg and 8 mg) did this in 87, 80, and 90% of cases, respectively. Risk factors for PONV are analyzed. The pathophysiological aspects of PONV and practical approaches to making an antiemetic strategy are discussed.     

昂丹司琼对全麻腹腔镜胆囊切除术患者术后恶心呕吐的影响及护理

目的 研究术中静脉注射昂丹司琼对腹腔镜胆囊切除术患者术后恶心呕吐(PONV)的影响及护理.方法 择期行全麻腹腔镜胆囊切除术患者90例,将患者随机分为3组各30例:小剂量昂丹司琼组(O1组),切皮前静脉注射4 mg昂丹司琼;大剂量昂丹司琼组(O2组),切皮前静脉注射8 mg昂丹司琼;对照组(C组),切皮前静脉注射生理盐水.所有注射液体均稀释为4 ml.观察术后24 h发生恶心呕吐的例数及程度.结果 与C组比较,O1组与O2组发生PONV的例数减少且程度减轻,P＜0.05;O1组与O2组之间比较差异无统计学意义,P＞0.05.结论 术中静脉注射昂丹司琼可以减少腹腔镜胆囊切除术后患者的恶心呕吐.     

Nausea and vomiting in the ambulatory surgical setting

Postoperative nausea and vomiting (PONV) is a significant problem in the ambulatory surgical setting. PONV results in delayed discharge, increased cost, and decreased patient satisfaction. Treating patients at risk for PONV preemptively before surgery can minimize these negative outcomes. Nurses play a key role in preventing PONV by first identifying patients at risk. Administering medication and fluids, providing comfort measures, and assessing the patient throughout the postoperative course are crucial nursing functions in the treatment of PONV. However, successful patient outcomes require a multidisciplinary approach. There have been great advances in the treatment of this common postoperative complication with improved anesthesia techniques and newer antiemetic drugs. Future research is needed to determine optimal combinations and timing of medications. Effective prevention and treatment of PONV improve patient outcomes and provide a more pleasant postoperative experience for the patient.     

微剂量异丙酚对术后恶心呕吐的作用

目的:异丙酚为镇静催眠药物,有研究表明其可能具有治疗术后恶心呕吐的作用。本研究通过对60例择期腹部肿瘤手术患者的观察,了解其对术后恶心呕吐的作用。方法:60例ASAI-Ⅱ择期腹部肿瘤手术患者,随机分为实验组和对照组,实验组在麻醉苏醒后静脉注入异丙酚0.2 mg/kg,对照组使用生理盐水2 mL。观察麻醉苏醒后6h内两组患者恶心呕吐的发生率以及镇静/清醒评分。结果:实验组在麻醉清醒后6 h内恶心发生率(16.6％)明显低于对照组(26.6％),P<0.05,但是呕吐发生率没有差异。结论:微剂量的异丙酚用于直接治疗术后恶心呕吐有一定的疗效,但是具体临床使用剂量以及时机尚需要进一步的研究。     

Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%.Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery.Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours.Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01).Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.     

Postoperative nausea and vomiting: understanding the enigma.

Postoperative nausea and vomiting (PONV) remains one of the most common complications related to surgery and anesthesia. Referred to as the "big little problem," PONV complications range from minor patient discomfort to gastric aspiration or death. There are multiple contributing factors that stimulate the vomiting reflex in PONV; yet, no single component is typically the causative factor. It usually is a variety of factors that trigger this response. Because the causes of PONV are multifactorial, no single antiemetic medication has been 100% effective for its prevention. A thorough understanding of these factors and the pharmacology related to PONV is essential for the effective management of this common postoperative complication.     

A randomized placebo-controlled study of aromatherapy for the treatment of postoperative nausea and vomiting

ObjectiveThe purpose of this study was to compare the aromatherapy treatment effects on PONV patients using ginger, lavender and rose oils and a placebo.DesignA randomized 4-armed placebo controlled study.SettingGaziosmanpasa University, School of Medicine, Health Research and Application Center.InterventionThe total of 184 patients were randomized into 4 groups: Aromatherapy with lavender essential oil (Lavender group), with rose essential oil (Rose group), with ginger essential oil (Ginger group) or with pure water (Placebo group).Main outcome measuresPostoperative nausea (0–3 Likert type; 0=no nausea, 1=some, 2=a lot, 3=severe) and vomiting scores (0–3 Likert type; 0=no vomiting, 1 = 1 time, 2 = 2 or 3 time, 3 = 4 times and up) and antiemetic medication requirement.ResultsThe nausea scores at 15 min were statistically significantly different between the groups (p = 0.00). The postoperative nausea scores improved in 20 (43.5%) subjects in the placebo group, 38 (82.6%) subjects in the lavender group, 22 (47.8%) subjects in the rose group and 30 (65.2%) subjects in the ginger group (p = 0.00). There were statistically significant differences between the groups with regard to the vomiting and antiemetic drug requirements (p = 0.00).ConclusionThe aromatherapy can be used as an alternative or complementary method for managing PONV. Specifically, the ginger and lavender essential oils were superior to the rose oil and pure water for the aromatherapy treatments. However, further studies with larger sample sizes are necessary to confirm these results.     

昂丹司琼对全麻腹腔镜胆囊切除术患者术后恶心呕吐的影响及护理

目的研究术中静脉注射昂丹司琼对腹腔镜胆囊切除术患者术后恶心呕吐（PONV）的影响及护理。方法择期行全麻腹腔镜胆囊切除术患者90例，将患者随机分为3组各30例：小剂量昂丹司琼组（O1组），切皮前静脉注射4mg昂丹司琼；大剂量昂丹司琼组（O2组），切皮前静脉注射8mg昂丹司琼；对照组（C组），切皮前静脉注射生理盐水。所有注射液体均稀释为4ml。观察术后24h发生恶心呕吐的例数及程度。结果与C组比较，O1组与O2组发生PONV的例数减少且程度减轻，P〈0．05；O1组与O2组之间比较差异无统计学意义，P〉0．05。结论术中静脉注射昂丹司琼可以减少腹腔镜胆囊切除术后患者的恶心呕吐。     

A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery

This randomized, double-blind study evaluated the relative efficacy of palonosetron (a new, selective 5-hydroxytryptamine type 3 [5-HT(3)] receptor antagonist) and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynaecological laparoscopic surgery. Patients received either palonosetron 0.075 mg (n = 45) or ondansetron 8 mg (n = 45), intravenously, immediately before induction of general anaesthesia. The occurrence of nausea and vomiting and the severity of nausea according to a visual analogue scale were monitored immediately after the end of surgery and during the following 24 h. The incidence of PONV was significantly lower in the palonosetron group compared with the ondansetron group (42.2% vs 66.7%, respectively). There were no significant statistical differences in the visual analogue scale for nausea. In conclusion, palonosetron 0.075 mg was more effective than ondansetron 8 mg in preventing PONV.     

柑橘属和甲氧氯普安在预防神经外科全麻术后恶心呕吐的观察

【摘要】目的 观察柑橘属和甲氧氯普安对预防神经外科全麻术后恶心呕吐的疗效差异。 方法 将2014年206例神经外科全麻术后患者,随机分为柑橘组103例,甲氧氯普安组103例,在术后回病房后3小时内观察期间,针对出现的PONV(恶心呕吐)症状,柑橘组使用自制柑橘属科果皮吸入及氧气雾化方法预防;甲氧氯普安组使用甲氧氯普安10mg肌肉注射方法。 结果 柑橘组和甲氧氯普安组均对神经外科全麻术后恶心呕吐具有明显的抑制作用,差异有统计学意义(P<0.05),而柑橘组和甲氧氯普安组总有效率比较差异无统计学意义(P>0.05),同比情况下柑橘组预防全麻术后恶心呕吐作用整体作用高。 结论 柑橘组对神经外科全麻术后恶心呕吐有明显的抑制作用,且方法操作简便,不存在药物副作用的潜在隐患,减少了患者住院药物费用,为预防全麻术后PONV(恶心呕吐)症状提供了新的方法。 【关键词】神经外科全麻手术;术后恶心呕吐;柑橘属;甲氧氯普安     

按压合谷、内关穴防治心胸外科全麻术后恶心与呕吐的效果

目的探讨心胸外科全麻术后患者采用按压合谷、内关穴的方法防治术后恶心、呕吐（PONV）的效果。方法将心胸外科手术全麻病史的患者60例,随机分为对照组和护理干预组,每组30例。对照组按全麻手术护理常规执行;护理干预组在全麻手术护理常规的基础上,术后2d内采用按压双侧合谷、内关穴的方法,观察比较患者术后恶心、呕吐症状。结果护理干预组术后恶心、呕吐的发生率显著低于对照组,差异有统计学意义（P〈0．01）。结论按压合谷、内关穴对心胸外科全麻术后恶心、呕吐具有明显的防治作用,值得临床推广应用。     

A comparative analysis of isopropyl alcohol and ondansetron in the treatment of postoperative nausea and vomiting from the hospital setting to the home

We compared the efficacy of inhaled isopropyl alcohol (IPA) with ondansetron for the control of postoperative nausea and vomiting (PONV) during a 24-hour period in 100 ASA class I-III women undergoing laparoscopic surgery. Nausea was measured postoperatively using a 0 to 10 verbal numeric rating scale (VNRS). The control group received ondansetron, 4 mg intravenously, and the experimental group inhaled IPA vapors. Breakthrough PONV was treated with 25-mg promethazine suppositories. Demographic and anesthesia characteristics were similar between groups. There was a significant difference between groups in mean +/- SD time to alleviation of PONV symptoms: for a 50% reduction in VNRS scores, 15.00 +/- 10.6 vs. 33.88 +/- 23.2 minutes was required in the experimental vs. the control group (P = .001). A total of 21 subjects (10 control; 11 experimental) reported PONV symptoms following discharge to home. The IPA treatment was successful in alleviating PONV symptoms in the home in 91% of the experimental group. We determined that using IPA after discharge from the postanesthesia care unit is a valuable method to control PONV in the hospital and at home. The results of this study suggest that IPA is much faster than ondansetron for 50% relief of nausea.     

Effect of postoperative supplemental oxygen on nausea and vomiting after cesarean birth.

Postoperative nausea and vomiting (PONV) has a significant impact on patients and health care providers. Some nonpharmacologic methods may have an effect on PONV. Administration of supplemental oxygen (80%) during and for 2 hours after surgery has been shown to reduce the incidence of PONV from 44% to 22%. However, the effect of limiting supplemental oxygen to the immediate postoperative period on PONV is unknown. The purpose of this study was to test the efficacy of postoperative supplemental oxygen in reducing the incidence of PONV. Patients (n = 106) undergoing cesarean birth were given general anesthesia with 50% oxygen balanced nitrous oxide and in the postoperative period were randomly assigned to 2 groups. Patients in the experimental group received 8 L/min oxygen by a simple face mask for 6 hours. The control group received routine care of oxygen 5 L/min in the PACU and no supplemental oxygen on the ward. Trained nurses evaluated pulse oximetry and PONV after surgery. The incidence of PONV during the first 6 postoperative hours was 28.3% in the experimental group and 24.5% in the control group ( P = .659). There was no statistically significant difference between the 2 groups. In this study, postoperative supplemental oxygen 8 L/min did not prevent PONV in patients undergoing cesarean birth.