The Study of Clinical Practice Guideline for Prevention of Postoperative Nausea and Vomiting (PONV) in Lopburi Cancer Hospital
Keywords:Postoperative nausea and vomiting, Clinical practice guideline, Ondansetron, Metoclopramide
Postoperative nausea and vomiting (PONV) are one of the most common complications after anesthesia that causes patient discomfort and may lead to a prolonged hospital stay. Therefore, Lopburi Cancer Hospital developed the clinical practice guideline (CPG) for PONV prophylaxis, but the effectiveness has not been investigated. This study aimed to determine the incidence of PONV based on PONV prophylaxis guidelines.The PONV in patients receiving ondansetron and metoclopramide were compared.This retrospective cohort study enrolled 365 patients undergoing general anesthesia for surgical procedures in Lopburi Cancer Hospital from August 2018 – May 2020. Retrospective data were collected from anesthetic records and medical records. According to the CPG, each patient was assessed for PONV risk by the simplified risk score and received prophylaxis medications. The overall incidence of PONV was 15.9%. In relation to PONV prophylaxis guideline, 91.3% received optimal prophylaxis. The incidence of PONV was 16.2% with optimal prophylaxis, which was no significant difference compared with the suboptimal & suboptimal prophylaxis groups. No significant difference in PONV prophylactic effect between ondansetron and metoclopramide was observed (OR 0.91, 95% CI 0.56-1.48). The incidence of PONV in Lopburi Cancer Hospital was high despite PONV prophylaxis usage following guidelines.This PONV prophylaxis guideline should be adjusted to improve PONV outcomes and suit our context.
Morino R, Ozaki M, Nagata O, Yokota M. Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center:First large-Scale Study in Japan. J Anesth 2013;27:18-24.
Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs 2000;59:213-43.
Gan TJ. Postoperative nausea and vomiting – Can it be eliminated? JAMA 2002;287:1233-6.
Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350:2441-51.
Murphy MJ, Hooper VD, Sullivan E, Clifford T, Apfel CC. Identification of risk factors for postoperative nausea
and vomiting in the perianesthesia adult patient. Journal of J Perianesth Nurs 2006;21:377-84.
Myles PS, William DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesthesia 2000;84:6-10.
Marla S, Stallard S. Systematic review of day surgery for breast cancer. Int J of Surgery 2009;7:318-23.
Habib AS, Chen YT, Taguchi A, Hu XH, Gan TJ. Postoperative nausea and vomiting following surgeries in a teaching hospital: A retrospective database analysis. Curr Med Res Opin 2006;22:1093-99.
Mace L. An audit of post-operative nausea and vomiting, following cardiac surgery:scope of the problem. Nursing in Critical Care 2003;5:187-96.
Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery–A prospective study. Can J Anaesth 1998; 45:612-9.
Tramer MR. Strategies for postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol 2004;18:693-701.
Watcha MF. Postoperative nausea and emesis. Anesthesiology Clin N Am 2002;20:709-22.
Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management
of postoperative nausea and vomiting. Society for Ambulatory Anesthesiology. Anesth Analg 2014;118:85-113.
Krobbuaban B, Pitakpol S, Diregpoke S.Ondansetron vs. metoclopamide for the prevention of nausea and vomiting after gynecologic surgery. J Med Assoc Thai 2008;91:669-74.
Sandhu T, Tanvatcharaphan P, Cheunjongkolkul V. Ondansetron vs. metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy. Asian J of Surgery 2008;31:50-4.
Bilgin TE, Birbicer H, Ozer Z, Doruk N, Tok E, Oral U. A comparative study of the antiemetic efficacy of dexamethasone, ondansetron, and metoclopramide in patients undergoing gynecological surgery. Med Sci Monit 2010;16:688-97.
Chen PP, Chui PT, Gin T. Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting after major gynaecological surgery. Eur J Anaesthesiol 1996;13:485-91.
Puntigo M. The Study of Clinical Practice Guideline for Prevention of Postoperative Nausea and Vomiting (PONV) in Potharam Hospital. Reg 4-5 Med J 2017;36:29-39.
Pongjanyakul S, Jimarsa T, Taesiri W, Gatekhlai B, Chau-In W, Wongswadiwat M. Effectiveness of Clinical Practice Guideline for the Prevention of Post Operative Nausea and Vomiting (PONV) in Srinagarind Hospital. Srinagarind Med J 2015; 30: 250-55.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology 1999;91:693-700.
McKenzie R, Kovac A, O’Connor T, Duncalf D, Angel J, Gratz I, et al. Comparison of ondansetron versus placebo to prevent postoperative nausea and vomiting in women undergoing ambulatory gynecologic surgery. Anesthesiology 1993;78:21-8.
Bodner M, White PF. Antiemetic efficacy of ondansetron after outpatient laparoscopy. Anesth Analg 1991;
Liberman MA, Howe S, Lane M. Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 2000;179:60-2.
Eberhart LH, Morin AM, Georgieff M. Dexamethason for prophylaxis of postoperative nausea and vomiting.
A meta-analysis of randomised controlled studies (German). Anaesthesist 2000;49:713-20.
Oliveira GS, Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii’s studies. Br J Anaesth 2012;109:688-97.
Gan TJ. Risk factors for postoperative nausea and vomiting. Anasth Analg 2006;102:1884 -98.
Apfel CC, Kranke P, Eberhart LH. Comparison of surgical site and patient’s history with a simplified risk score
for the prediction of postoperative nausea and vomiting. Anaesthesia 2004;59:1078-82.
บทความทีตีพิมพ์ในวารสารโรคมะเร็งนี้ถือว่าเป็นลิขสิทธิ์ของมูลนิธิสถาบันมะเร็งแห่งชาติ และผลงานวิชาการหรือวิจัยของคณะผู้เขียน ไม่ใช่ความคิดเห็นของบรรณาธิการหรือผู้จัดทํา