Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-13T06:15:25.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under spinal anaesthesia: a randomized study of ondansetron prophylaxis

Published online by Cambridge University Press:  29 June 2005

E. Kontrimaviciute ,
A. Baublys  and
J. Ivaskevicius
E. Kontrimaviciute
Affiliation:
Vilnius University, Anesthesiology and Intensive Care Clinic, Vilnius University Hospital “Santariskiu Klinikos”, Vilnius, Lithuania
A. Baublys
Affiliation:
Vilnius University, Anesthesiology and Intensive Care Clinic, Vilnius University Hospital “Santariskiu Klinikos”, Vilnius, Lithuania
J. Ivaskevicius
Affiliation:
Vilnius University, Anesthesiology and Intensive Care Clinic, Vilnius University Emergency Hospital, Vilnius, Lithuania
Get access

Extract

Summary

Background and objective: Patients undergoing total abdominal hysterectomy under general anaesthesia have a high risk of developing postoperative nausea and vomiting (PONV). The aim of this study was to evaluate the incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with intravenous patient-controlled analgesia (PCA) using morphine and to compare its incidence with and without antiemetic prophylaxis. Methods: Thirty-four patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine postoperatively were divided into two groups. The first (n = 17) received ondansetron prophylaxis near the end of surgery while the second (n = 17) received no prophylaxis. Morphine consumption, emetic episodes (on a 3-point scale), patient satisfaction (visual analogue score), sedation and pruritus were evaluated 2, 4, 6, 9, 12, 18 and 24 h postoperatively. Results: Patient characteristics, postoperative morphine consumption (43.3 ± 7.6 vs. 40.3 ± 12.3 mg) and peristaltic recovery time (16.9 ± 5 vs. 18.4 ± 5.2 h) were similar in both groups. Overall nausea and vomiting were significantly lower in the ondansetron prophylaxis group than in the group without prophylaxis (52.9% vs. 88.2%, P < 0.05). Though nausea alone was higher in the prophylaxis group (41.2% vs. 29.4%), nausea with vomiting was significantly lower in the prophylaxis group (11.8% vs. 58.8%, P < 0.01). Patients' satisfaction scores were higher in the ondansetron group at all times and the difference was significant (P < 0.05) 4 h postoperatively. Conclusions: The incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine is very high (88.2%). Antiemetic prophylaxis with ondansetron is highly recommended in this patients group resulting in a lower incidence of nausea and vomiting, and significantly improves patient' satisfaction and life quality in the early postoperative period.

Keywords

ANAESTHETIC TECHNIQUES, spinal anaesthesiaANAESTHETICS, LOCAL, bupivacaineANALGESIA, patient-controlled analgesia, pain measurementOPIOIDS, morphinePOSTOPERATIVE COMPLICATIONS, pain, postoperative nausea and vomitingSURGERY, hysterectomy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 7 , July 2005 , pp. 504 - 509
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment and prevention. Anesthesiology 1992; 77: 162–184.Google Scholar
Gan TJ, Meyer T, Apfel CC et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97: 62–71.Google Scholar
Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109–118.Google Scholar
Kenny GN. Risk factors for postoperative nausea and vomiting. Anaesthesia 1994; 49 (Suppl): 6–10.Google Scholar
Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–449.Google Scholar
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78: 7–16.Google Scholar
Rawal N, Jones RM, Aitkenhead AR, Foex P. Management of Acute and Chronic Pain. London: BMJ Books, 1998: 66–70.
Thomas R, Jones N. Prospective randomized, double-blind comparative study of dexamethasone, ondansetron, and ondansetron plus dexamethasone as prophylactic antiemetic therapy in patients undergoing day-case gynaecological surgery. Br J Anaesth 2001; 87: 588–592.Google Scholar
Zeitz K, McCutcheon H, Albrecht A. Postoperative complications in the first 24 hours: a general surgery audit. J Adv Nurs 2004; 46: 633–640.Google Scholar
Apfel CC, Roewer N. Postoperative nausea and vomiting. Anaesthesist 2004; 63: 377–389.Google Scholar
Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth 1992; 69: S24–S32.Google Scholar
Okamura K, Sanuki M, Kinoshita H et al. Study of nausea and vomiting accompanying intravenous patient-controlled analgesia with fentanyl after cervical spine surgery. Masui 2003; 52: 1181–1185.Google Scholar
Chimbira W, Sweeney BP. The effect of smoking on postoperative nausea and vomiting. Anaesthesia 2000; 55: 1032–1033.Google Scholar
Sartain JB, Barry JJ, Richardson CA, Branagan HC. Effect of combining naloxone and morphine for patient-controlled analgesia. Anesthesiology 2003; 99: 148–151.Google Scholar
Biedler A, Wermelt J, Kunitz O et al. A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anaesth 2004; 51: 13–19.Google Scholar
Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth 2004; 51: 326–341.Google Scholar
Sidebotham DA, Reddy M, Schug SA. Influence of postoperative pain therapy on nausea and vomiting. Schmerz 1997; 11: 241–246.Google Scholar
Abouleish EI, Rashid S, Haque S, Giezentanner A, Joynton P, Chuang AZ. Ondansetron versus placebo for control of nausea and vomiting during Caesarean section under spinal anaesthesia. Anaesthesia 1999; 54: 479–482.Google Scholar
Fujii Y, Tanaka H, Toyooka H. Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for Caesarean section: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 1998; 42: 921–925.Google Scholar
Alexander R, Lovell AT, Seingry D, Jones RM. Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia. Anaesthesia 1995; 50: 1086–1088.Google Scholar
Maxwell LG, Kaufmann S, Bitzer S et al. The effects of a small-dose naloxone on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia; a double-blind, prospective, randomized, controlled study. Anesth Analg 2005; 100: 953–958.Google Scholar
Tramer MR, Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review. Anesth Analg 1999; 88: 1354–1361.Google Scholar
Biedler A, Wermelt J, Kunitz O et al. A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anaesth 2004; 51: 13–19.Google Scholar
Piper SN, Trien JG, Rohen KD, Kranke P, Moleck WH, Boldt J. Prevention of postoperative nausea and vomiting. Randomized comparison of dolasetron versus dolasetron plus dexamethasone. Anaesthesist 2003; 52: 120–126.Google Scholar
Apfel CC, Korttila K, Abdalla M et al. An international multicenter protocol to assess the single and combined benefits of antiemetic interventions in a controlled clinical trial of a 2 × 2 × 2 × 2 × 2 × 2 factorial design (IMPACT). Control Clin Trials 2003; 24: 736–751.Google Scholar
Apfel CC, Bacher A, Biedler A et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. Anesthetist 2005; 54: 201–209.Google Scholar