Françoise Bardiau

Difference in risk factors for postoperative nausea and vomiting.

Background It is commonly stated that risk factors for postoperative nausea are the same as for vomiting. The authors designed a prospective study to identify and differentiate the risk factors for postoperative nausea and vomiting in various surgical populations in a clinical audit setting. Methods The study included 671 consecutive surgical inpatients, aged 15 yr or more, undergoing various procedures. The study focused on postoperative nausea visual analog scale scores every 4 h and vomiting episodes within 72 h. Both vomiting and retching were considered as emetic events. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. The bivariate Dale model for binary correlated outcomes was used to identify selectively the potential risk factors of postoperative nausea and vomiting. Results Among the 671 patients in the study, 126 (19%) reported one or more episodes of nausea, and 66 patients (10%) suffered one or more emetic episodes during the studied period. There was a highly significant association between the two outcomes. Some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, and general anesthesia). History of migraine and type of surgery were mainly responsible for nausea but not for vomiting. The predictive effect of risk factors was controlled for postoperative pain and analgesic drugs. Conclusion This study shows that differences exist in risk factors of postoperative nausea and vomiting. These could be explained by differences in the physiopathology of the two symptoms.

Assessment of postoperative nausea using a visual analogue scale.

Background: Assessment of postoperative nausea intensity is difficult because nausea is a subjective and unpleasant sensation. We propose using the Visual Analogue Scale (VAS) device to increase the efficiency and precision in the assessment of nausea. We carried out a pilot study on postoperative patients suffering from nausea to measure the degree of agreement between the VAS scores and those given on a 4‐point verbal descriptive scale (VDS).

Continuous Epidural Infusion of Large Concentration/Small Volume Versus Small Concentration/Large Volume of Levobupivacaine for Postoperative Analgesia

In this randomized study, we evaluated the quality of postoperative analgesia and the incidence of side effects of continuous thoracic epidural levobupivacaine 15 mg/h in 2 different concentrations: 0.5%, 3 mL/h (n = 33) or 0.15%, 10 mL/h (n = 27). The following variables were registered within 48 h: sensory block, pain scores, rescue morphine consumption, motor blockade, hemodynamics, sedation, nausea and vomiting, and patient satisfaction. The two groups were similar with regard to demographics, cephalad level of sensory block, quality of analgesia, morphine consumption, side effects, and high satisfaction rate. Motor blockade was weaker in the 0.5% group (P = 0.025), with a significantly increased hemodynamic stability, compared with the 0.15% group (P = 0.004). In conclusion, the same dose of levobupivacaine provides an equal quality of analgesia in small- or large-volume continuous epidural infusion and decreases the incidence of motor blockade and hemodynamic repercussions. This is in accordance with the assumption that the total dose of local anesthetics determines the spread and quality of analgesia.

Effectiveness of an acute pain service inception in a general hospital

STUDY OBJECTIVES To assess the effects of an Acute Pain Service (APS) inception on postoperative pain management in a general teaching hospital using pain indicators as performance measures. DESIGN Open, prospective, nonrandomized, observational study. SETTING Postanesthesia Care Unit, surgical wards of University Hospital Center of Charleroi. PATIENTS 1304 patients in the pre-APS inception phase and 671 patients after its implemention who have undergone various types of surgery (orthopedics, gynecology, urology, neurosurgery, stomatology, ear, nose, and throat, ophthalmic, abdominal, vascular-thoracic, plastic, and maxillofacial). INTERVENTIONS An APS, nurse-based, anesthesiologist-supervised model was devised, based on the concept that postoperative pain relief can be greatly improved by providing in-service training for surgical nursing staff and optimal use of systemic analgesics. MEASUREMENTS AND MAIN RESULTS Postoperative pain was assessed using a visual analog scale (VAS) every 4 hours for 72 hours in the two phases. Analgesic consumption was registered at the same time. Time-related VAS scores were summarized using several pain indicators. There was an overall improvement in the pain scores after APS inception. The differences were most pronounced, around 50%, in patients undergoing vascular, maxillofacial, gynecologic, and urologic surgeries, and stomatology. Regular administration of paracetamol and nonsteroidal antiinflammatory drugs decreased morphine consumption in the second phase. CONCLUSION This study validates the benefits of a formal APS, using continuous monitoring of rest pain intensity and analgesic consumption in the postoperative period. Results not only support previous research findings but also offer outcome-based tools to evaluate current practices as compared with desired outcomes.

Comparison of different concentrations of levobupivacaine for post-operative epidural analgesia

Background:  The relative effects of the mass, volume and concentration of local anaesthetic solution used for epidural anaesthesia and analgesia are still under debate. Clinical studies have shown discrepancies, probably because of limited consideration of total dose.

Tropisetron in the prevention of postoperative nausea and vomiting

STUDY OBJECTIVES To evaluate the efficacy of tropisetron, a selective 5-HT(3) receptor antagonist, in preventing nausea and vomiting in high-risk inpatients undergoing various surgical procedures. DESIGN Prospective, open, nonrandomized, observational, interventional study. SETTING Postanesthesia care unit, and surgical wards of the University Hospital Center, Charleroi. PATIENTS A total of 1,132 elective surgical inpatients (>15 years of age) in two separate surveys. The first prospective survey covered all surgical adult inpatients (n = 671) after various surgical procedures over a 3-month period. A new 3-month survey was performed to assess the effectiveness of the preventive measure and included another 461 patients. INTERVENTIONS Risk factors associated with nausea and vomiting were recorded in the first survey and used to establish an antiemetic policy. This consisted in the administration of tropisetron 2 mg intravenously after anesthesia induction, if two patient-related risk factors associated with high-risk surgery and general anesthesia were present. MEASUREMENTS AND MAIN RESULTS Nausea frequency and intensity, assessed every 4 hours using a visual analog scale (VAS), frequency and times of vomiting episodes and the need for rescue medication were recorded for 72 hours postoperatively. Nausea was experienced by 18.8% and vomiting by 9.8% of the patients in the first survey (211 high risk-patients of 671). In the second survey, 137 patients of 461, considered at high-risk received prophylactic tropisetron. The proportion of patients having nausea decreased to 11.1% (p,178 0.01) and vomiting episodes to 2.8% (p < 0.001). Twenty-six of the tropisetron-treated patients (19%) suffered subsequent postoperative nausea and vomiting (PONV). Patient satisfaction with tropisetron was high. CONCLUSION Prophylactic tropisetron can reduce the incidence of PONV in selected high-risk inpatients undergoing various types of surgical procedures.

Low vs. high concentration of levobupivacaine for post-operative epidural analgesia: influence of mode of delivery

Background:  Although the use of continuous epidural infusion (CEI) and patient‐controlled epidural analgesia (PCEA) has become commonplace in pain management, there is still controversy regarding the relative effects of mass, volume and concentration of the local anaesthetic. This prospective study evaluated the influence of two concentrations of levobupivacaine on the quality of analgesia in two modes of delivery after lower abdominal surgery.

Programme d'amélioration de la gestion de la douleur post-opératoire

Resume Objectif L’etude, conduite avant et apres la mise en place d’un Acute Pain Service (APS) au sein d’un hopital de 1 005 lits, decrit le processus d’implantation d’un APS. Les departements infirmier, anesthesie et chirurgie ont ete impliques. Dans cette etude nous avons cherche a evaluer les resultats d’un programme d’amelioration continue en definissant des indicateurs de qualite et en utilisant des outils qualite. Un programme qualite repondant aux recommandations de traitement de la douleur aigue (multimodale) a ete etabli pour ameliorer le soulagement de la douleur de tous les patients chirurgicaux hospitalises. Patients/Materiel et methodes Une etude des connaissances infirmieres concernant la douleur post-operatoire (DPO) a ete realisee et l’echelle visuelle analogique (EVA) a ete introduite pour mesurer l’intensite de la douleur. Les infirmieres et les medecins ont ete informes des procedures basees sur les preuves concernant la DPO. L’ensemble du processus a ete evalue par trois etudes consecutives incluant 2 383 patients chirurgicaux. Les indicateurs douleur bases sur l’EVA et les consommations d’analgesiques ont ete enregistres durant les premieres 72 heures post-operatoires. A la suite de la premiere etude concernant le traitement antalgique habituel, un APS base sur les infirmieres et supervise par un anesthesiste a ete implante. L’amelioration du soulagement de la douleur, exprime par les scores EVA, a ete evalue par deux etudes successives. Un manuel qualite a ete ecrit et implante. Resultats Une amelioration majeure des scores douleur a ete observee apres la mise en œuvre de l’APS (P Conclusion Les ameliorations ont ete maintenues au cours du temps et demontrees par la derniere etude.