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Volume 15 Issue 2
Mar.  2024
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WU Juelun, TIAN Yuan, NIE Weihua, ZHANG Yuelun, SHEN Le. Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579
Citation: WU Juelun, TIAN Yuan, NIE Weihua, ZHANG Yuelun, SHEN Le. Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579
shu

Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia

  • 1.

    Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds: 

National High Level Hospital Clinical Research Funding 2022-PUMCH-A-147

More Information
  • Corresponding author:

    SHEN Le, E-mail: pumchshenle@163.com

  • Received Date: November 29, 2023
  • Accepted Date: March 10, 2024
  • Available Online: March 18, 2024
  • Issue Publish Date: March 29, 2024
    Graphical Abstract
    • Abstract
  •   Objective  To identify the risk factors for postoperative nausea and vomiting (PONV) in surgical patients undergoing patient controlled intravenous analgesia (PCIA).
      Methods  Our study was a retrospective cohort study, including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31, 2023 and received PCIA after surgery. Patient characteristics, medical history, surgical information, intraoperative medication information, postoperative analgesia follow-up information were obtained through the electronic medical record system. The patients were divided into PCIA-PONV group and non-PCIA-PONV group, depending on the occurrence of PONV during PCIA, and all patients were also divided into PCIA-POV group and non-PCIA-POV according to whether postoperative vomiting (POV) occurred. Multivariate Logistic regression analysis was used to identify the risk factors for PCIA-PONV and PCIA-POV.
      Results  A total of 1373 patients were included in this study, with 676 cases in PCIA-PONV group. The incidence of PCIA-PONV was 49.2%. There were 285 patients in PCIA-POV group, and the incidence of PCIA-POV was 20.8%. The results of multivariate Logistic regression analysis showed that female (OR=2.134, 95% CI: 1.590-2.865, P < 0.001) and abdominal surgery (OR=1.655, 95% CI: 1.253-2.186, P < 0.001) were risk factors for PCIA-PONV, whereas the increase of age (OR=0.990, 95% CI: 0.982-0.998, P=0.019) and the increase of BMI (OR=0.961, 95% CI: 0.932-0.991, P=0.012) were protective factors for PCIA-PONV. Female (OR=2.646, 95% CI: 1.754-3.992, P < 0.001), history of general anesthesia (OR=1.372, 95% CI: 1.042-1.806, P=0.024), and intraoperative use of high-dose opioids (OR=1.607, 95% CI: 1.206-2.142, P=0.001) were risk factors for PCIA-POV, whereas no intraoperative use of neuromuscular blocking antagonists (OR=0.393, 95% CI: 0.237-0.651, P < 0.001) was protective factor for PCIA-POV.
      Conclusions  Our study reveals the risk factors for PONV in surgical patients undergoing PCIA, and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA-PONV.
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    • References (18)
  • [1]
    Apfel C C, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers[J]. Anesthesiology, 1999, 91(3): 693-700. DOI: 10.1097/00000542-199909000-00022
    [2]
    Gan T J, Belani K G, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131(2): 411-448. DOI: 10.1213/ANE.0000000000004833
    [3]
    Macintyre P E. Safety and efficacy of patient-controlled analgesia[J]. Br J Anaesth, 2001, 87(1): 36-46. DOI: 10.1093/bja/87.1.36
    [4]
    Oh C S, Jung E, Lee S J, et al. Effect of nefopam- versus fentanyl-based patient-controlled analgesia on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a prospective double-blind randomized controlled trial[J]. Curr Med Res Opin, 2015, 31(8): 1599-1607. DOI: 10.1185/03007995.2015.1058251
    [5]
    Darvall J, Handscombe M, Maat B, et al. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies[J]. Can J Anaesth, 2021, 68(7): 1057-1063. DOI: 10.1007/s12630-021-01974-8
    [6]
    Weber J, Schmidt J, Wirth S, et al. Context-sensitive decrement times for inhaled anesthetics in obese patients explored with Gas Man®[J]. J Clin Monit Comput, 2021, 35(2): 343-354. DOI: 10.1007/s10877-020-00477-z
    [7]
    El-Serag H B, Graham D Y, Satia J A, et al. Obesity is an Independent risk factor for GERD symptoms and erosive esophagitis[J]. Am J Gastroenterol, 2005, 100(6): 1243-1250. DOI: 10.1111/j.1572-0241.2005.41703.x
    [8]
    Lambert D M, Marceau S, Forse R A. Intra-abdominal pressure in the morbidly obese[J]. Obes Surg, 2005, 15(9): 1225-1232. DOI: 10.1381/096089205774512546
    [9]
    Volkow N D, Wang G J, Fowler J S, et al. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology[J]. Philos Trans R Soc Lond B Biol Sci, 2008, 363(1507): 3191-3200. DOI: 10.1098/rstb.2008.0107
    [10]
    Boden G, Chen X, Mozzoli M, et al. Effect of fasting on serum leptin in normal human subjects[J]. J Clin Endocrinol Metab, 1996, 81(9): 3419-3423.
    [11]
    Kim J H, Hong M, Kim Y J, et al. Effect of body mass index on postoperative nausea and vomiting: propensity analysis[J]. J Clin Med, 2020, 9(6): 1612. DOI: 10.3390/jcm9061612
    [12]
    Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention[J]. J Visc Surg, 2016, 153(6): 439-446. DOI: 10.1016/j.jviscsurg.2016.08.010
    [13]
    Turner D A, Smith G. Evaluation of the combined effects of atropine and neostigmine on the lower oesophageal sphincter[J]. Br J Anaesth, 1985, 57(10): 956-959. DOI: 10.1093/bja/57.10.956
    [14]
    Hood D D, Eisenach J C, Tuttle R. Phase Ⅰ safety assessment of intrathecal neostigmine methylsulfate in humans[J]. Anesthesiology, 1995, 82(2): 331-343. DOI: 10.1097/00000542-199502000-00003
    [15]
    Tramèr M R, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review[J]. Br J Anaesth, 1999, 82(3): 379-386. DOI: 10.1093/bja/82.3.379
    [16]
    Chhabra R, Gupta R, Gupta L K. Sugammadex versus neostigmine for reversal of neuromuscular blockade in adults and children: a systematic review and meta-analysis of randomized controlled trials[J]. Curr Drug Saf, 2024, 19(1): 33-43. DOI: 10.2174/1574886318666230302124634
    [17]
    Hawker G A, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Question-naire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)[J]. Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S240-S252.
    [18]
    中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX201806002.htm

    Chinese Medical Association Surgery Branch, Chinese Medical Association Anesthesiology Branch. Chinese expert consensus and pathway management guidelines for accelerated rehabilitation surgery (2018 Edition)[J]. Chin J Pract Surg, 2018, 38(1): 1-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX201806002.htm
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