Efficacy and costs of 3 anesthetic regimens in the prevention of postoperative nausea and vomiting.

STUDY OBJECTIVE: The aim of the study was to compare the antiemetic efficacy and costs associated with 3 different anesthesia regimens used in gynecologic laparoscopy. DESIGN: This was a randomized, controlled study. SETTING: The study was conducted at a university hospital. PATIENTS: We studied 150 ASA physical status I or II patients, undergoing elective gynecologic laparoscopy with general anesthesia. INTERVENTION: Patients were allocated into the following 3 groups: group P-preoperative placebo tablet, propofol induction, propofol-air/O2 maintenance; group I + O-preoperative 8-mg ondansetron tablet, thiopental induction, isoflurane-N2O maintenance; group I (control)-preoperative placebo tablet, thiopental induction, isoflurane-N2O maintenance. MEASUREMENTS: The frequency of postoperative nausea and vomiting (PONV), number needed to treat to prevent PONV, and the costs of the anesthetic drugs to prevent PONV in one additional patient were evaluated. MAIN RESULTS: The frequency of PONV within the 24-hour study period was lowest in group I + O (P, 38%; I + O, 33%; and I, 59%; P < 0.05 I + O vs I). The number needed to treat was 5 in group P and 4 in group I + O, compared with group I. The median costs of anesthetic drugs to prevent PONV in one additional patient were $65 in group P and dollar 68 in group I + O, compared with group I. CONCLUSIONS: We conclude that in gynecologic laparoscopy, propofol-air/O2 anesthesia alone, and isoflurane-N2O anesthesia combined with an oral 8-mg dose of ondansetron had similar efficacy and costs to prevent PONV. Isoflurane-N2O anesthesia without ondansetron was less expensive, but was also less efficacious.

Ketoprofen for add-on pain treatment to paracetamol after strabismus surgery in children.

OBJECTIVE: To evaluate whether combining ketoprofen, a nonsteroidal anti-inflammatory analgesic, with paracetamol would provide better postoperative analgesia than paracetamol alone in children undergoing strabismus surgery. STUDY DESIGN: A prospective, double-blind, randomised clinical trial. PATIENTS AND METHODS: 56 generally healthy children, aged 3-15 years, undergoing strabismus surgery with standardised endotracheal anaesthesia were randomly assigned to receive either ketoprofen 1 mg/kg intravenously or normal saline at induction of anaesthesia and a second dose 3h later. All children received paracetamol 24 mg/kg solution orally 60 min before surgery and fentanyl 2 mug/kg intravenously during surgery. For rescue analgesia during the first 6h children in pain (pain score >3 on an 11-point scale: 0 = no pain, 10 = worst possible pain) received fentanyl 1 mug/kg intravenously. Any episodes of vomiting and all other adverse events were recorded for the first 24h. RESULTS: 21 of 27 children in the ketoprofen-paracetamol group (78%) and 23 of 29 in the paracetamol group (79%) received fentanyl for rescue analgesia. The mean (SD) number of fentanyl doses during the first 6h was 1.2 (0.9) in the ketoprofen-paracetamol group and 1.7 (1.1) doses in the paracetamol group (mean difference 0.5 doses; 95% CI for difference: -0.1, 1.3; p = 0.11). Eight (30%) vomited in the ketoprofen-paracetamol group and 14 in the paracetamol group (48%) [difference 19%; 95% CI -6, 44; p = 0.15). No serious adverse events occurred. CONCLUSION: Neither paracetamol nor ketoprofen-paracetamol provided sufficient analgesia for children after strabismus surgery because most needed rescue analgesia.

A prospective study on postoperative pain after cataract surgery.

PURPOSE: To evaluate postoperative pain and early recovery in cataract patients. PATIENTS AND METHODS: A total of 201 patients who underwent elective first eye cataract extraction surgery were enrolled, and 196 were included in the final analysis. The study design was a single-center, prospective, follow-up study in a tertiary hospital in eastern Finland. Postoperative pain was evaluated with the Brief Pain Inventory at four time points: at baseline, and at 24 hours, 1 week, and 6 weeks postsurgery. RESULTS: Postoperative pain was relatively common during the first hours after surgery, as it was reported by 67 (34%) patients. After hospital discharge, the prevalence decreased; at 24 hours, 1 week, and 6 weeks, 18 (10%), 15 (9%) and 12 (7%) patients reported having ocular pain, respectively. Most patients with eye pain reported significant pain, with a score of ≥4 on a pain scale of 0-10, but few had taken analgesics for eye pain. Those who had used analgesics rated the analgesic efficacy of paracetamol and ibuprofen as good or excellent. Other ocular irritation symptoms were common after surgery; as a new postoperative symptom, foreign-body sensation was reported by 40 patients (22%), light sensitivity by 29 (16%), burning by 15 (8%), and itching by 15 (8%). CONCLUSION: Moderate or severe postoperative pain was relatively common after cataract surgery. Thus, all patients undergoing cataract surgery should be provided appropriate counseling on pain and pain management after surgery.

Supplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.

UNLABELLED: Supplemental 80% oxygen administration halves the incidence of postoperative nausea and vomiting (PONV) in inpatients. Whether it prevents PONV after ambulatory surgery is unknown. We tested the efficacy of supplemental 80% oxygen in decreasing the incidence of PONV after ambulatory gynecologic laparoscopy. One hundred patients were given a standardized sevoflurane anesthetic. They were randomly assigned to two groups: routine oxygen administration with 30% oxygen, balance nitrogen (Group A); and supplemental oxygen with 80% oxygen, balance nitrogen (Group B). Oxygen was administered during surgery and up to 1 h after surgery. The incidence of nausea and vomiting and the need for rescue antiemetics did not differ between the groups in the postanesthesia care unit, in the Phase II unit, or during the 24-h follow-up. The overall incidence of nausea and vomiting during the first postoperative 24 h was 62% in Group A and 55% in Group B (P = 0.486). There were no differences in the recovery profiles and patient satisfaction between the groups. In this study, supplemental oxygen did not prevent PONV in patients undergoing ambulatory gynecologic laparoscopy. IMPLICATIONS: Supplemental 80% oxygen administration during surgery and until 1 h after surgery compared with 30% oxygen administration did not prevent postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.