ZHANG Le, SONG Kaicheng, SHEN Le. Multimodal Strategy of Postoperative Nausea and Vomiting Management as A Key Component of Enhanced Recovery after Surgery: Summary of the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 490-495. DOI: 10.12290/xhyxzz.2021-0189
Citation: ZHANG Le, SONG Kaicheng, SHEN Le. Multimodal Strategy of Postoperative Nausea and Vomiting Management as A Key Component of Enhanced Recovery after Surgery: Summary of the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 490-495. DOI: 10.12290/xhyxzz.2021-0189

Multimodal Strategy of Postoperative Nausea and Vomiting Management as A Key Component of Enhanced Recovery after Surgery: Summary of the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

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  • Corresponding author:

    申乐  电话:010-69152026, E-mail: shenle@pumch.cn

    SHEN Le  Tel: 86-10-69152026, E-mail: shenle@pumch.cn

  • Received Date: February 08, 2021
  • Accepted Date: March 07, 2021
  • Available Online: June 06, 2021
  • Issue Publish Date: July 29, 2021
  • Postoperative nausea and vomiting(PONV) is one of the common complications after surgery and unfavourable for postoperative recovery. As an important part of anesthesia, the management of PONV is also a part of enhanced recovery after surgery(ERAS). With the continuous renewal and development of ERAS concept, the understanding, prevention and treatment of PONV have been improved among medical workers. In August 2020, the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting was released. This guideline has been updated for the overall management of PONV to provide multimodal management strategies, which mainly include recognition of risk factors, risk stratification, prevention measures and remedial treatment of PONV in adults and children. With a view to providing clinical reference for the standardized management of PONV in adults and children, this paper makes a detailed interpretation of the key points and updated contents of the guidelines.
  • [1]
    Apfel Christian 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: 693-693. DOI: 10.1097/00000542-199909000-00022
    [2]
    Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2020, 131: 411-448. DOI: 10.1213/ANE.0000000000004833
    [3]
    Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design[J]. Br J Anaesth, 2002, 88: 659-668. DOI: 10.1093/bja/88.5.659
    [4]
    Gan TJ, Glass PSA, Howell ST, et al. Determination of Plasma Concentrations of Propofol Associated with 50% Reduction in Postoperative Nausea[J]. Anesthesiology, 1997, 87: 779-784. DOI: 10.1097/00000542-199710000-00010
    [5]
    Schaefer MS, Kranke P, Weibel S, et al. Total intravenous anaesthesia versus single-drug pharmacological antiemetic prophylaxis in adults: A systematic review and meta-analysis[J]. Eur J Anaesthesiol, 2016, 33: 750-760. DOI: 10.1097/EJA.0000000000000520
    [6]
    Apfel CC, Turan A, Souza K, et al. Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis[J]. Pain, 2013, 154: 677-689. DOI: 10.1016/j.pain.2012.12.025
    [7]
    Scott MJ, McEvoy MD, Gordon DB, et al. Correction to: American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home[J]. Perioper Med (Lond), 2018, 7: 4. DOI: 10.1186/s13741-018-0086-7
    [8]
    Aksoy M, Ince I, Ahiskalioglu A, et al. Effect of intra-venous preoperative versus postoperative paracetamol on postoperative nausea and vomiting in patients undergoing strabismus surgery: A prospective randomized study[J]. Agri, 2018, 30: 1-7. http://europepmc.org/abstract/MED/29450877
    [9]
    Forget P, Tombal B, Scholtes JL, et al. Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer? [J]. Eur J Anaesthesiol, 2011, 28: 830-835. DOI: 10.1097/EJA.0b013e32834b7d9a
    [10]
    Marret E, Kurdi O, Zufferey P, et al. Effects of Nons-teroidal Antiinflammatory Drugs on Patient-controlled Analgesia Morphine Side Effects: Meta-analysis of Randomized Controlled Trials[J]. Anesthesiology, 2005, 102: 1249-1260. DOI: 10.1097/00000542-200506000-00027
    [11]
    Elia N, Lysakowski C, Tramèr Martin R. Does Multimodal Analgesia with Acetaminophen, Nonsteroidal Antiinflammatory Drugs, or Selective Cyclooxygenase-2 Inhibitors and Patient-controlled Analgesia Morphine Offer Advantages over Morphine Alone?: Meta-analyses of Randomized Trials[J]. Anesthesiology, 2005, 103: 1296-1304. DOI: 10.1097/00000542-200512000-00025
    [12]
    Gan TJ, Joshi GP, Zhao SZ, et al. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects[J]. Acta Anaesthesiol Scand, 2004, 48: 1194-1207. DOI: 10.1111/j.1399-6576.2004.00495.x
    [13]
    Bakri MH, Ismail EA, Ibrahim A. Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J]. Korean J Anesthesiol, 2015, 68: 254-260. DOI: 10.4097/kjae.2015.68.3.254
    [14]
    Shariffuddin II, Teoh WH, Wahab S, et al. Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study[J]. BMC Anesthesiol, 2018, 18: 3. DOI: 10.1186/s12871-017-0464-6
    [15]
    Collard V, Mistraletti G, Taqi A, et al. Intraoperative esmolol infusion in the absence of opioids spares postopera-tive fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy[J]. Anesth Analg, 2007, 105: 1255-1262, table of contents.
    [16]
    Weibel S, Rucker G, Eberhart LH, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis[J]. Cochrane Database Syst Rev, 2020(10): CD012859. DOI: 10.1002/14651858.CD012859/full
    [17]
    Weibel S, Jokinen J, Pace NL, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis[J]. Br J Anaesth, 2016, 116: 770-783. DOI: 10.1093/bja/aew101
    [18]
    Echevarria GC, Altermatt FR, Paredes S, et al. Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children: A randomised controlled trial[J]. Eur J Anaesthesiol, 2018, 35: 343-348. DOI: 10.1097/EJA.0000000000000807
    [19]
    Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways[J]. Can J Anaesth, 2015, 62: 203-218. DOI: 10.1007/s12630-014-0275-x
    [20]
    Hristovska AM, Duch P, Allingstrup M, et al. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults[J]. Cochrane Database Syst Rev, 2017(8): CD012763. http://www.ncbi.nlm.nih.gov/pubmed/28806470
    [21]
    Jun JH, Kim KN, Kim JY, et al. The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis[J]. Can J Anaesth, 2017, 64: 947-961. DOI: 10.1007/s12630-017-0917-x
    [22]
    Singh PM, Borle A, Gouda D, et al. Efficacy of palonosetron in postoperative nausea and vomiting (PONV)-a meta-analysis[J]. J Clin Anesth, 2016, 34: 459-482. DOI: 10.1016/j.jclinane.2016.05.018
    [23]
    Xiong C, Liu G, Ma R, et al. Efficacy of palonosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis[J]. Can J Anaesth, 2015, 62: 1268-1278. DOI: 10.1007/s12630-015-0457-1
    [24]
    Li Y, Wei X, Zhang S, et al. A Meta-Analysis of Palonosetron for the Prevention of Postoperative Nausea and Vomiting in Adults[J]. J Perianesth Nurs, 2015, 30: 398-405. DOI: 10.1016/j.jopan.2015.05.116
    [25]
    Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2014, 118: 85-113. DOI: 10.1213/ANE.0000000000000002
    [26]
    Diemunsch P, Gan TJ, Philip BK, et al. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase Ⅲ trial in patients undergoing open abdominal surgery[J]. Br J Anaesth, 2007, 99: 202-211. DOI: 10.1093/bja/aem133
    [27]
    Liu G, Gong M, Wang Y, et al. Effect of Methylprednisolone on Pain Management in Total Knee or Hip Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials[J]. Clin J Pain, 2018, 34: 967-974. DOI: 10.1097/AJP.0000000000000614
    [28]
    Habib AS, Kranke P, Bergese SD, et al. Amisulpride for the Rescue Treatment of Postoperative Nausea or Vomiting in Patients Failing Prophylaxis: A Randomized, Placebo-controlled Phase Ⅲ Trial[J]. Anesthesiology, 2019, 130: 203-212. DOI: 10.1097/ALN.0000000000002509
    [29]
    Khademi S, Ghaffarpasand F, Heiran HR, et al. Effects of preoperative gabapentin on postoperative nausea and vomit-ing after open cholecystectomy: a prospective randomized double-blind placebo-controlled study[J]. Med Princ Pract, 2010, 19: 57-60. DOI: 10.1159/000252836
    [30]
    Som A, Bhattacharjee S, Maitra S, et al. Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis[J]. Anesth Analg, 2016, 123: 1418-1426. DOI: 10.1213/ANE.0000000000001617
    [31]
    Ormel G, Romundstad L, Lambert-Jensen P, et al. Dexamethasone has additive effect when combined with ondansetron and droperidol for treatment of established PONV[J]. Acta Anaesthesiol Scand, 2011, 55: 1196-1205. DOI: 10.1111/j.1399-6576.2011.02536.x
    [32]
    Cho E, Kim DH, Shin S, et al. Efficacy of Palonosetron-Dexamethasone Combination Versus Palonosetron Alone for Preventing Nausea and Vomiting Related to Opioid-Based Analgesia: A Prospective, Randomized, Double-blind Trial[J]. Int J Med Sci, 2018, 15: 961-968. DOI: 10.7150/ijms.24230
    [33]
    Jabalameli M, Honarmand A, Safavi M, et al. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded compari-son of midazolam, ondansetron, and a combination[J]. Adv Biomed Res, 2012, 1: 2. DOI: 10.4103/2277-9175.94424
    [34]
    Gupta R, Soto R. Prophylaxis and management of postoperative nausea and vomiting in enhanced recovery protocols: Expert Opinion statement from the American Society for Enhanced Recovery (ASER)[J]. Perioper Med (Lond), 2016, 5: 4. DOI: 10.1186/s13741-016-0029-0
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