Rcsi Institute of Leadership Ponv Literature Review

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PONV was not seen at 24 hours significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used

Habib, et al. (2010)

prospective, double-blind, randomized study

104 Patients undergoing craniotomy

Patients were randomized to receive oral aprepitant 40 mg (or matching placebo) 1 to 3 hours before induction of anesthesia or ondansetron 4 mg IV (or placebo) within 30 minutes of the end of surgery.

comparison

Data were collected at regular intervals by blinded personnel for 48 hours after surgery. Statistical analysis was performed using Wilcoxon's ranked sum test and ?(2) test. P < 0.05 was considered statistically significant.

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cumulative incidence of vomiting at 48 hours was 16% in the aprepitant group and 38% in the ondansetron group (P = 0.0149). The incidence of vomiting was also decreased in the aprepitant group at 2 hours (6% vs. 21%, P = 0.0419) and 24 hours (14% vs. 36%, P = 0.0124). From 0 to 48 hours, there was no difference between the aprepitant and ondansetron groups in the incidence of nausea (69% vs. 60%), nausea scores, need for rescue antiemetics (65% vs. 60%), complete response (no PONV and no rescue, 22% vs. 36%), or patient satisfaction with the management of PONV.

combination of aprepitant and dexamethasone was more effective than was the combination of ondansetron and dexamethasone for prophylaxis against postoperative vomiting in adult patients undergoing craniotomy under general anesthesia. However, there was no difference between the groups in the incidence or severity of nausea, need for rescue antiemetics, or in complete response between the groups.

Vigneault, et al. ((2010)

Systematic review of literature

29 Studies involving 1754 patients

MEDLINE, EMBASE, Cochrane, and SCOPUS databases

Literature review summative dose and safety of IVLI should be established before recommending its use.

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At six hours postoperatively, intravenous lidocaine infusion reduced pain at rest (weighted mean difference [WMD] -8.70, 95% confidence intervals [CI] -16.19 to -1.

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21), during cough (WMD -11.19, 95% CI -17.73 to -4.65), and during movement (WMD -9.56, 95% CI -17.31 to -1.80). Intravenous lidocaine infusion also reduced opioid requirement (morphine) (WMD -8.44 mg, 95% CI -11.32 to -5.56), time to first flatus (WMD -7.62 hr, 95% CI -10.78 to -4.45), time to first feces (WMD -10.71 hr, 95% CI -16.14 to -5.28), nausea/vomiting (risk ratios = 0.71, 95% CI 0.57-0.90), and hospital length of stay (WMD -0.17 days, 95% CI -0.41 to 0.07).

Rhee, et al. (2010)

Survey.

1191 patients

Surveys

Longitudinal

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Postoperative backache and dissatisfaction

The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%

Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.

Simurina et al. (2010)

Prospective, randomized, double-blinded, controlled study.

120 ASA physical status I and II women, aged 21 to 76 years, undergoing elective gynecologic laparoscopic surgery.

Patients were randomized to receive a gas mixture of 30% oxygen in air (FIO (2) = 0.3, Group G30), 50% oxygen in air (FIO (2) = 0.5, Group G50), or 80% oxygen in air (FIO (2) = 0.8, Group G80); there were 36 patients in each group. A standardized sevoflurane general anesthesia, postoperative pain management, and antiemetic regimen were used.

Frequency of nausea, vomiting, and both was assessed for early (0 to two hrs) and late PONV (two to 24 hrs), along with use of rescue antiemetic, degree of nausea, and severity of pain.

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G80 patients had significantly less vomiting than Group.....

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