Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy

Citation
Pe. Scuderi et al., Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy, ANESTH ANAL, 91(6), 2000, pp. 1408-1414
Citations number
24
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
91
Issue
6
Year of publication
2000
Pages
1408 - 1414
Database
ISI
SICI code
0003-2999(200012)91:6<1408:MAMPEP>2.0.ZU;2-Y
Abstract
Because no completely effective antiemetic exists for the prevention of pos toperative nausea and vomiting (PONV), we hypothesize that a multimodal app roach to management of PONV may reduce both vomiting and the need for rescu e antiemetics in high-risk patients. After IRB approval, women undergoing o utpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. P atients undergoing the same surgical procedure who received a standard bala nced outpatient anesthetic with ondansetron 4 mg (Group II, n = 42) or plac ebo (Croup III, n = 37) prophylaxis were chosen to establish baseline incid ence of nausea and vomiting. None of the Group I patients vomited before di scharge, compared with 7% in Group II (P = 0.07) and 22% in Group III (P = 0.0003). However, one patient (2%) in Group I required treatment for sympto ms in the postanesthesia care unit, compared with 24% in Group II IP ( 0.00 01) and 41% in Group III (P < 0.0001). Time to discharge-ready was signific antly shorter in Group I(128, 118-139 min; mean, 95% confidence interval) v ersus Group II (162, 145-181 min; P = 0.0015) and Group III (192, 166-222 m in; P = 0.0001). Patient satisfaction with control of PONV was not differen t between Group I and Group II. Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management result ed in a 98% complete response rate and a 0% incidence of vomiting before di scharge; however, this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis. We conclude that both multimodal management and routine monotherapy antiemeti c prophylaxis resulted in an increased level of patient satisfaction than s ymptomatic treatment in this high-risk population.