K. Korttila

How to study postoperative nausea and vomiting.

Anesthesiological journals are flooded by innumerable studies of postoperative nausea and vomiting (PONV). Nevertheless, PONV remains a continuing problem with an average incidence of 20–30%. This paper should provide essential information for the design, conduct, and presentation of these studies. It should also increase comparability among future studies and help clinicians in assessing and reading the literature on PONV.

Persistent pain after caesarean section and vaginal birth: a cohort study

BACKGROUNDnAlthough persistent pain has been described to occur after various types of surgery, little is known about this entity following caesarean section or vaginal birth. We sought to examine the association between mode of delivery and development of persistent pain, as well as the nature and intensity of the pain.nnnMETHODSnA questionnaire was sent to 600 consecutive Finnish-speaking women within one year of their giving birth. The survey recorded the womens health history, obstetric history, previous pain, details of the caesarean section or vaginal birth, and a description of their pain, if present.nnnRESULTSnPersistent pain one year after delivery was significantly more common after caesarean section (42/229, 18%) than after vaginal birth (20/209, 10%: P=0.011, OR 2.1 with 95% CI 1.2-3.7). The persistent pain was mild in 55% of the patients in both groups, and intense or unbearable for four caesarean sections and six vaginal births. Persistent pain was significantly more common in women with previous pain (P=0.013), previous back pain (P=0.016), and any chronic disease (P=0.016). The women with persistent pain recalled significantly more pain on the day after caesarean section (P=0.004) and vaginal birth (P=0.001) than those who did not report persistent pain.nnnCONCLUSIONnPersistent pain is more common one year after a caesarean section than after vaginal birth. A history of previous pain and pain on the day after delivery correlated with persistent pain.

Nitrous oxide does not increase nausea and vomiting following gynaecological laparoscopy

The effect of three different anaesthetic techniques on the incidence and severity of postoperative emesis (nausea, retching and vomiting) was studied in 150 patients undergoing gynaecological laparoscopy. Patients were anaesthetized with isoflurane in nitrous oxide and oxygen (Group A), enflurane in nitrous oxide and oxygen (Group B) or with isoflurane in air and oxygen (Group C). Groups had been predetermined by date of birth. During the first 24 hours after the operation no difference was found at any time in the incidence or severity of emesis among the groups. The overall incidence of emesis during the first 24 hours postoperatively was 54, 48 and 52 per cent, in groups A, B and C, respectively. It is concluded that nitrous oxide does not increase the incidence of emesis after isoflurane anaesthesia and that isoflurane and enflurane anaesthesia are associated with similar incidences of nausea and vomiting after gynaecological laparoscopy.Résuméľeffet de trois différentes techniques anesthésiques sur ľincidence et la sévérité du vomissement postopératoire (nausées, haut-le-cour et vomissements) a été étudié chez 150 patientes devant subir une laparoscopie pour opérations gynécologiques. Les patientes furent anesthésiées avec isoflurane, protoxyde ďazote et oxygène (Groupe A), enflurane, protoxyde ďazote et oxygène (Groupe B) ou avec isoflurane, air et oxygène (Groupe C). Les groupes ont été prédéterminés par la date de naissance. Durant les premières 24 heures postop aucune différence ne fut mentionnée en aucun temps sur ľincidence ou la sévérité des vomissements entre les groupes. ľincidence totale des vomissements durant les premières 24 heures postopératoires était de 54, 48 et 52 pour cent dans les groupes A, B et C respectivement. On conclut que le protoxyde ďazote n’augmente pas ľincidence des vomissements après ľanesthésie à V isoflurane et que ľanesthésie à ľisoflurane et ľnflurane est associée avec une incidence identique de nausées et vomissements après laparoscopie pour opération gynécologique.

Balanced analgesia improves recovery and outcome after outpatient tubal ligation

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission.

Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour : a randomised, controlled, double-blinded study

Background: We hypothesised that intravenous patient‐controlled analgesia (IV PCA) with remifentanil could provide as satisfactory pain relief for labour as epidural analgesia.

Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four groups on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre+menstrum) (Pd 25–6), early follicular phase (Pd 8–12), ovulatory phase (Pd13–15) and luteal phase (Pd20–24). The overall incidence of nausea and vomiting was 46%. Statistically significant differences in the incidence of nausea and retching were found among the groups by regression analysis. The incidence of nausea and vomiting was highest in women undergoing laparoscopy during the luteal phase (77%), which was greater than during the follicular phase (32%) or during pre+menstruation (18%). The need for antiemetic was highest in women undergoing laparoscopy during the luteal phase (69%) and this was different from the follicular (18%, P <0,01) and pre+menstrum (19%, P<0,01) phases. It is concluded that the highest incidence of postoperative nausea and vomiting after gynaecological laparoscopy occurs during the luteal phase.RésuméLes nausées et les vomissements postopératoires ont été comparés chez 68 femmes ayant des menstruations régulières et subissant une laparoscopie gynécologique. Les patientes furent divisées en quatre groupes en se basant sur la phase de leur cycle menstruel comme suit: prémenstruation-menstruation (pré+menstruations) (Pd25–6), la phase folliculaire précoce (Pd8–12), la phase ovulatoire (Pd13–15) et la phase lutéale (Pd 20–24). L’incidence globale de nausées et de vomissements était de 46%. Une différence statistiquement significative fut trouvée entre les groupes par analyse de régression. L’incidence de nausées et de vomissements était plus grande chez les femmes subissant la laparoscopie durant la phase lutéale (77%) et cette incidence fut plus grande que lors de la phase folliculaire (32%) ou durant la phase de pré+menstruation (18%). Le besoin d’antiémétique était plus grand chez les femmes subissant la laparoscopie durant la phase lutéale (69%) et ceci était différent du groupe en phase folliculaire (18%, P< 0,01) et du groupe pré-menstruel (19%, P<0,01). On conclut que la plus haute incidence de nausées et de vomissements après laparoscopie est survenue lors de la phase lutéale.

Recovery from sevoflurane and isoflurane anaesthesia after outpatient gynaecological laparoscopy

As the low blood solubility (blood gas partition coefficient 0.69) of sevoflurane suggests a rapid emergence from anaesthesia, recovery from sevoflurane anaesthesia was compared to isoflurane in outpatient gynaecological laparoscopy. Fifty ASA I or II, consenting women participated in a randomised, controlled and single blind study. The patients received, after induction of anaesthesia with propofol, either sevoflurane or isoflurane, both with 67% nitrous oxide in oxygen, for maintenance of anaesthesia. The study drug was administered at 1 MAC (end tidal concentration 0.6% for sevoflurane and 0.5% for isoflurane) but adjusted in 0.5 MAC steps, if clinically indicated. Before the end of surgery the end tidal concentration of the study drug was reduced to 0.5 MAC. Recovery assessments were made from the time anaesthetic gases were discontinued. The subjects were able to open eyes in 2.3 (0.8–7.0) min and 4.1 (2.0–6.8) min, orientate in 2.8 (1.0–6.8) min and 4.7 (2.2–8.3) min and follow orders in 2.6 (0.7–6.8) min and 4.3 (1.2–7.3) min, in the sevoflurane and isoflurane groups, respectively (P<0.05) [median (range)]. Walking was achieved in 72 (24–464) min and 66 (35—134) min, tolerance of oral fluids in 37 (15–88) min and 35 (45–161) min and voiding in 262 (96–459) min and 217 (52–591) min in the sevoflurane and isoflurane groups, respectively (NS). Overall home readiness was achieved in 281 (96–708) min after sevoflurane group and 242 (96–591) min after isoflurane (NS). Postoperative nausea and vomiting was common in both groups (55% for sevoflurane and 45% for isoflurane) and contributed to three subjects in the sevoflurane group and four in the isoflurane group being admitted to hospital.

Ondansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery.

Background:u2002 Although intraspinal morphine has been shown to be effective in providing analgesia after cesarean delivery, pruritus as a side‐effect remains a common cause of dissatisfaction. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory.

The experience of the person ventilating the lungs does influence postoperative nausea and vomiting

One hundred and ninety‐eight patients undergoing elective abdominal hysterectomy were anaesthetized with isoflurane in nitrous oxide and oxygen. Ventilation before endotracheal intubation was carried out either by an experienced senior or by an inexperienced junior member of the anaesthetic team. The incidence and severity of emesis (none, nausea, retching or vomiting) were assessed five times during the first 24 h after operation. Patients whose lungs had been ventilated by experienced members of staff had significantly less (P<0.05 to 0.01) postoperative emesis in the recovery room (incidence of emesis 35%) and 2–6 h after operation (incidence 27%) when compared to patients whose lungs had been ventilated by inexperienced members of staff (incidence of emesis 54% and 40% in the recovery room and after 2 to 6 h, respectively). The results suggest that the experience of the person ventilating the lungs is associated with postoperative nausea and vomiting.

Recovery and outcome after propofol and isoflurane anesthesia in patients undergoing laparoscopic hysterectomy

Background: Laparoscopic hysterectomy (LH) is expected to provide fast and comfortable recovery, plus an early return to normal daily activities. This study was carried out to compare the outcome after LH in patients anesthetized with isoflurane or propofol.