Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy

• Published in: Anesthesia and analgesia Vol. 91; no. 6; pp. 1408 - 1414
• Main Authors: SCUDERI, Phillip E, JAMES, Robert L, HARRIS, Lynne, MIMS, Grover R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.12.2000
• Subjects: Adult; Algorithms; Ambulatory Surgical Procedures; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiemetics - administration & dosage; Antiemetics - therapeutic use; Biological and medical sciences; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Gynecologic Surgical Procedures; Humans; Laparoscopy; Medical sciences; Pain, Postoperative - drug therapy; Postoperative Nausea and Vomiting - prevention & control; Single-Blind Method; Survival Analysis; Treatment Outcome; Opiates; Narcotic analgesic; Remifentanil; Prevention; Vomiting; Complication; Female; Ambulatory; Antagonist; Propofol; Human; Postoperative; Endoscopic surgery; General anesthesia; Laparoscopy; Nausea; Algorithm; Female genital diseases; Chemotherapy; General anesthetic; 5-HT3 Serotonine receptor; Digestive diseases; Therapeutic protocol; Antiemetic; Ondansetron
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200012000-00020

Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting (PONV), we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients. After IRB approval, women undergoing outpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. Patients undergoing the same surgical procedure who received a standard balanced outpatient anesthetic with ondansetron 4 mg (Group II, n = 42) or placebo (Group III, n = 37) prophylaxis were chosen to establish baseline incidence of nausea and vomiting. None of the Group I patients vomited before discharge, 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 symptoms in the postanesthesia care unit, compared with 24% in Group II (P<0.0001) and 41% in Group III (P< 0.0001). Time to discharge-ready was significantly shorter in Group I (128, 118-139 min; mean, 95% confidence interval) versus Group II (162, 145-181 min; P = 0.0015) and Group III (192, 166-222 min; P = 0.0001). Patient satisfaction with control of PONV was not different between Group I and Group II. Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management resulted in a 98% complete response rate and a 0% incidence of vomiting before discharge; 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 antiemetic prophylaxis resulted in an increased level of patient satisfaction than symptomatic treatment in this high-risk population.