The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone

이세진,이수명,김순임,옥시영,김상호,박선영,김문규 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.3

Background: The purpose of this study was to evaluate the effect of an aprepitant, neurokinin-1(NK1) receptor antagonist, for reducing postoperative nausea and vomiting (PONV) for up to 24 hours in patients regarded as high risk undergoing gynecological surgery with intravenous patient-controlled analgesia (IV PCA) using fentanyl. Methods: In this randomized, open label, case-control study 84 gynecological surgical patients receiving a standardized general anesthesia were investigated. Patients were randomly allocated to receive aprepitant 80 mg P.O. approximately 2-3 hours before operation (aprepitant group) or none (control group). All patients received ramosetron 0.3 mg IV after induction of anesthesia. The incidence of PONV, severity of nausea, and use of rescue antiemetics were evaluated for up to 24 hours postoperatively. Results: The incidence of nausea was significantly lower in the aprepitant group (50.0%) compared to the control group (80.9%) during the first 24 hours following surgery. The incidence of vomiting was significantly lower in the aprepitant group (4.7%) compared to the control group (42.8%) during the first 24 hours following surgery. In addition, the severity of nausea was less among those in the aprepitant group compared with the control group over a period of 24 hours post-surgery (P < 0.05). Use of rescue antiemetics was lower in the aprepitant group than in the control group during 24 hours postoperatively (P < 0.05). Conclusions: In patients regarded as high risk undergoing gynecological surgery with IV PCA using fentanyl, the aprepitant plus ramosetron ware more effective than ramosetron alone to decrease the incidence of PONV, use of rescue antiemetics and nausea severity for up to 24 hours postoperatively. Background: The purpose of this study was to evaluate the effect of an aprepitant, neurokinin-1(NK1) receptor antagonist, for reducing postoperative nausea and vomiting (PONV) for up to 24 hours in patients regarded as high risk undergoing gynecological surgery with intravenous patient-controlled analgesia (IV PCA) using fentanyl. Methods: In this randomized, open label, case-control study 84 gynecological surgical patients receiving a standardized general anesthesia were investigated. Patients were randomly allocated to receive aprepitant 80 mg P.O. approximately 2-3 hours before operation (aprepitant group) or none (control group). All patients received ramosetron 0.3 mg IV after induction of anesthesia. The incidence of PONV, severity of nausea, and use of rescue antiemetics were evaluated for up to 24 hours postoperatively. Results: The incidence of nausea was significantly lower in the aprepitant group (50.0%) compared to the control group (80.9%) during the first 24 hours following surgery. The incidence of vomiting was significantly lower in the aprepitant group (4.7%) compared to the control group (42.8%) during the first 24 hours following surgery. In addition, the severity of nausea was less among those in the aprepitant group compared with the control group over a period of 24 hours post-surgery (P < 0.05). Use of rescue antiemetics was lower in the aprepitant group than in the control group during 24 hours postoperatively (P < 0.05). Conclusions: In patients regarded as high risk undergoing gynecological surgery with IV PCA using fentanyl, the aprepitant plus ramosetron ware more effective than ramosetron alone to decrease the incidence of PONV, use of rescue antiemetics and nausea severity for up to 24 hours postoperatively.

부인과 수술 환자의 수술 전 금식기간 탈수량이 수술 후 오심,구토에 미치는 영향

황윤정 ( Yun Jeong Hwang ),박소미 ( So Mi Park ) 여성건강간호학회 2015 여성건강간호학회지 Vol.21 No.1

Purpose: The purpose of this study was to investigate the effect of dehydration from preoperative fasting on postoperative nausea and vomiting in patients who underwent gynecologic surgeries. Methods: Study design was a prospective descriptive study. A total of 75 patients in a university hospital were selected. Data were collected from March 17 to May 16, 2014 using self-report questionnaires and clinical electronic chart. Results: Factors influencing the development of postoperative nausea and vomiting were type of surgery (t=3.44, p=.001), use of PCA (t=-2.16, p=.034), and preoperative dehydration level (t=5.93, p<.001), and these variables accounted for 51.7% of postoperative nausea and vomiting. Among these variables, preoperative dehydration amount (β=.56) showed the largest influence in the difference in postoperative nausea and vomiting. Conclusion: Reducing dehydration during preoperative fasting can prevent occurrence of postoperative nausea and vomiting. Development of a clinical guideline is necessary to give directions for the prevention of dehydration during preoperative fasting and to ensure the proper duration of fasting according to patient characteristics, type of surgery and time of surgery.

갑상선 절제술을 받은 환자에서 P6 Acupressure의 술 후 오심, 구토에 대한 예방 효과

라세희 ( Se Hee Na ),김나영 ( Na Young Kim ),길혜금 ( Hae Keum Kil ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

Background: Postoperative nausea and vomiting (PONV) is a common problem in patients recovering from anesthesia and surgery. P6 point is the acupressure point for prevention of postoperative nausea and vomiting. We evaluated the efficacy of acupressure at the P6 point in 94 patients undergoing thyroidectomy in a randomized, prospective and placebo-controlled study. Methods: Ninety-four female patients, aged 18 to 60, scheduled for elective thyroidectomy, were randomized to have either placebo band or acupressure band (Sea-Band(R) UK Ltd., Leicestershire, England, UK) applied to the P6 point of both hands before induction of anesthesia. The acupressure bands removed 24 h later. Postoperative nausea and vomiting was evaluated 1, 6 and 24 h following surgery. In addition, the need for rescue antiemetic medication during 24 h was registered. Results: The incidence of postoperative nausea was lower in acupressure group at 0-1 h (16.7% vs. 39.1%; P=0.015) and at 6-24 h (0% vs. 15.2%; P=0.05). The need for rescue antiemetic medication was also lower at 0-1 h (4.2% vs. 23.9%; P=0.006), at 1-6 h (6.2% vs. 20.9%; P=0.039) and at 6-24 h (0% vs. 13%; P=0.012). Conclusions: In patients undergoing thyroidectomy, nausea and need of rescue antiemetic medication were reduced by acupressure at the P6 point. (Korean J Anesthesiol 2009;56:413~8)

정맥내 통증자가조절장치로 투여된 Fentanyl과 Ketorolac이 수술 후 오심 구토에 미치는 영향

신영근,나병수,박정원,우영철,김진윤,박선규 중앙대학교 의과대학 의과학연구소 2003 中央醫大誌 Vol.28 No.2-3

This study was performed to assess the effect of fentanyl and ketorolac in intravenous patient-controlled analgesia (IV-PCA) on postoperative nausea and vomiting. And we also evaluated the antiemetic effect of ondansetron. Ninety three patients who were undergoing elective operation of three departments (gynecology, GY; general surgery, GS; orthopedic surgery, OS) received enflurane anesthesia and IV-PCA. The IV-PCA device was filled with fentanyl 12-15 pg/kg, ketorolac 4-5 mg/kg and normal saline into total dose of 65 ml. After loading 5 ml of the above solution, the IV-PCA was started at a setting of 0.5 ml/h of basal infusion rate and 0.5 ml per demand, with 15 minutes lockout interval. Patients undergoing abdominal surgery were randomly allocated into ondansetron group and non-ondansetron group based on the addition of ondansetron 4 mg into the IV-PCA device. We assessed the incidence of nausea, vomiting by departments and ondansetron usage at operation day (OD), postoperative day 1 (POD1) and 2 (POD2). The incidence of nausea was 34%, 10.3% and 0% at OD in GY, GS and 0s respectively. There was no difference between ondansetron group and non-ondansetron group in the incidence of nausea and vomiting. The patients who received gynecological operation showed higher rate of postoperative nausea and vomiting at OD and PODI. Also, addition of ondansetron into IV-PCA with fentanyl and ketorolac did not reduce the incidence of postoperative nausea and vomiting in abdominal operation.

Comparison of Ramosetron Dose in Patients with Postoperative Nausea and Vomiting Who Received Oxycodone-Based Intravenous Patient-Controlled Analgesia after Undergoing Gynecological Laparoscopic Surgery

Hyung Youn Gong 순천향대학교 순천향의학연구소 2018 Journal of Soonchunhyang Medical Science Vol.24 No.2

Objective: Pain that occurs following gynecological laparoscopic surgery is a main cause for prolonged hospitalization. As a solution, various intravenous patient-controlled analgesia (IV PCA) systems have been used to control postoperative pain. This study explored the relationship between the dose of the ramosetron used to control postoperative nausea and vomiting (PONV) and its effect when oxycodone was used as the IV PCA. Methods: Ninety-two patients (age, 18–70 years) undergoing gynecological laparoscopic surgery received oxycodone as IV PCA and were divided into the RB and RM group. Towards the end of surgery, the RB group patients were given 0.3 mg ramosetron as an IV bolus, and those in the RM group were given 0.3 mg ramosetron plus and additional 0.6 mg as IV PCA. The degree of PONV, postoperative pain, and pain felt during coughing were observed for 0.5, 2, 4, 8, 24, and 48 hours postoperatively. Patient satisfaction and comfort were assessed at 24 and 48 hours. Results: No differences in operation time, anesthesia period, or amounts of propofol and remifentanil used were observed between the groups. IV PCA demand, severity of PONV, postoperative pain, and coughing pain were also similar between the groups. Patient comfort was similar between the groups at 24 and 48 hours postoperatively. Conclusion: No difference in the incidence of PONV was detected between patients who used only 0.3 mg ramosetron as an intravenous bolus and those who received an additional 0.6 mg ramosetron mixed in IV PCA when oxycodone was offered as the IV PCA after undergoing gynecological laparoscopic surgery.

Postoperative pain and side effects after thyroidectomy: randomized double blind study comparing nefopam and ketorolac

유보라,권재영,황보영,홍정민,김태균,김해규 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.2

Background: Nefopam is a centrally acting, non-opioid analgesicdrug used to reduce opioid consumption and so reduce theprevalence of postoperative nausea and vomiting (PONV). Thisstudy compared and assessed the effects of nefopam and ketorolacon postoperative pain and PONV after thyroid surgery. Methods: Two hundred patients underwent total thyroidectomywith central compartment neck dissection in our hospital during a5 month enrollment period. Group N and Group T was administerednefopam 20 mg and ketorolac 30 mg, respectively, during the last30 minutes of surgery. Pain was measured using a 10-pointnumerical rating scale. Pain scores and PONV were assessed 30min, 1, 6, and 24 h postoperatively. Results: Pain scores and episodes of vomiting and shivering didnot differ significantly between the two groups. Group N patientsexperienced fewer episodes of nausea at 30 min, 1 h and 6 h afterthe operation. Conclusions: Nefopam and ketorolac are similarly effective inreducing postoperative pain after thyroid surgery. Postoperativenausea was less in Group N patients within 6 h postoperatively,especially 1 h. Nefopam is favored for pain management afterthyroidectomy.

Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery

김유일,Soo Yeong Moon,Dong Un Song,Ki Hyun Lee,Jae Wook Song,Young Eun Kwon 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.2

Background: Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. Methods: One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. Results: There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. Conclusions: The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA.

The preventative effect of ramosetron on postoperative nausea and vomiting after total thyroidectomy

이동철,곽현정,김홍순,Sung Ho Choi,이지연 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.2

Background: Postoperative nausea and vomiting (PONV) frequently develops in patients undergoing thyroidectomy,and propofol-based total intravenous anesthesia (TIVA) has been reported to reduce the incidence of PONV. The present study was undertaken to compare the effects of ramosetron on PONV in women following total thyroidectomy under TIVA. Methods: One hundred and thirty women scheduled for thyroidectomy were allocated to either a control group (n = 65) or a ramosetron group (n = 65). Propofol in combination with remifentanil was used for TIVA in all patients. 2 ml of either intravenous saline (control group) or 0.3 mg of ramosetron (ramosetron group) were administered at the end of the surgery. Fentanyl-based patient-controlled analgesia was implemented for 48 h after surgery in all patients. The incidences and severities of PONV, pain scores, administrations of rescue antiemetics, and the side effects of the antiemetics were documented during the first 48 h after surgery. Results: The incidences of complete response (no PONV, no rescue) in the control and ramosetron groups were 71%and 88%, respectively, during the first 6 h (P = 0.029), 85% and 94% during the next 6 to 24 h period (P = 0.155), and 97% and 95% during the last 24 to 48 h period (P = 1.00). During the first 6 h, the severity of nausea and the use of rescue antiemetic medication were significantly lower in the ramosetron group. Conclusions: Ramosetron was found to be effective at reducing the incidence and severity of postoperative nausea in women that underwent total thyroidectomy with propofol-based TIVA, especially during the first 6 hours postoperatively.

Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Mohamed H. Bakri,Eman A. Ismail,Ahmed Ibrahim 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3

Background: Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC. Methods: Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 μg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded. Results: Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported. Conclusions: Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

예방적으로 투여한 Dolasetron과 마취 유도제로 사용한 Propofol이 갑상선 절제술 후 오심과 구토에 미치는 영향

조한범 ( Han Bum Joe ),박은정 ( Eun Jung Park ),박선경 ( Sun Kyung Park ),김은진 ( Eun Jin Kim ),박재홍 ( Jae Hong Park ),최정웅 ( Jeong Woong Choi ),김진수 ( Jin Soo Kim ),이숙영 ( Sook Young Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Background: Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing thyroidectomy. In this study we evaluated the effects of prophylactic dolasetron and/or induction with propofol on PONV. Methods: Two hundred three patients scheduled thyroidectomy under general anesthesia with sevoflurane were included and were randomly allocated to one of four groups. In control (group C) and dolasetron groups (group D), the patients received thiopental sodium 4-5 mg/kg intravenously for the induction of anesthesia, and the patients in group D received prophylactic intravenous dolasetron 210 μg/kg. In propofol (group P) and dolasetron+propofol groups (group D+P), the patients received propofol 2 mg/kg intravenously for the induction of anesthesia, and the patients in group D+P received prophylactic intravenous dolasetron 210 μg/kg. The incidence and severity of PONV, the need for rescue antiemetics, adverse events were assessed during 0 to 1 hour and 1 to 24 hours postoperatively. Results: During the first 24 hours after anesthesia, the incidences of PONV and postoperative vomiting were significantly reduced in group D+P compared with group C (P<0.05, respectively). There were no significant differences in postoperative nausea, need for rescue antiemetics, severity of PONV, and adverse events of antiemetics among the four groups. Conclusions: In patients with thyroidectomy, combination of prophylactic dolasetron administration and induction with propofol was found to reduce the incidence of PONV during the first 24 hours after anesthesia, compared with that of routine induction with thiopental sodium. (Korean J Anesthesiol 2009;57:320∼6)