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SHORT COMMUNICATION
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 18-21

A prospective survey of postoperative nausea and vomiting: Its prevalence and risk factors


1 Department of Basic Medical Science, Tripoli Higher Institute for Medical Professions, Tripoli, Libya
2 Department of Anesthesia and Intensive Care, Faculty of Medical Technology, University of Tripoli, Tripoli, Libya
3 Department of Pharmacy, University of Tripoli Alahlia, Tripoli, Libya

Date of Web Publication26-Mar-2019

Correspondence Address:
Dr. E Ahmed Atia
Department of Anesthesia and Intensive Care, Faculty of Medical Technology, University of Tripoli, Tripoli
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_26_18

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  Abstract 


Background: To improve the efforts that try to detect the common risk factors of postoperative nausea and vomiting (PONV), this epidemiologic survey was designed to evaluate the present incidence of PONV for different types of common surgical procedures among patients of Tripoli Medical Center, Tripoli, Libya. Methods: Over a period of 6 months, the prospective interview-based survey included more than 170 elective surgical inpatients aged between 18 and >65 years and received general or regional anesthesia was done by the authors. Results: Among the 170 patients surveyed in this study, the incidence of PONV at the recovery room was 28.2% and 22.3%, respectively. Over the whole 24 h period, the incidence of PONV was gradually increased to 32.3% and 25.8%, respectively. The highest prevalence of PONV was observed in the gynecology patients. Female patients were suffered from both nausea and vomiting more than male patients. Besides, PONV in patients who received general anesthesia was much more common than those who received regional anesthesia in both observation periods (the recovery room and the ward). Conclusion: Our study shows various risk factors of PONV. These factors could help to increase the possibility of recognizing patients at risk for PONV.

Keywords: Nausea, postoperative, surgical, vomiting


How to cite this article:
Abired N A, Elmahmoudi M H, Bkhait A N, Atia E A. A prospective survey of postoperative nausea and vomiting: Its prevalence and risk factors. Libyan J Med Sci 2019;3:18-21

How to cite this URL:
Abired N A, Elmahmoudi M H, Bkhait A N, Atia E A. A prospective survey of postoperative nausea and vomiting: Its prevalence and risk factors. Libyan J Med Sci [serial online] 2019 [cited 2019 Jun 18];3:18-21. Available from: http://www.ljmsonline.com/text.asp?2019/3/1/18/254952




  Introduction Top


Globally, anesthesia is given to more than 75 million surgical patients each year. One-third of them will suffer from postoperative nausea, vomiting, or both if they were untreated.[1],[2],[3] Postoperative nausea and vomiting (PONV) and postoperative pain are among one of the most common and disturbing complications following anesthesia and surgery. Adult patients often rate PONV as worse than postoperative pain.[4],[5] Many studies reported that the incidence of PONV ranges from 20% to 30% of patients, whereby the highest occurrence can be found in the first 6 h after operation.[6],[7]

It has been suggested that PONV may increase the risk of unwarranted side effects, such as pulmonary aspiration, esophageal rupture, bilateral pneumothoraxes, and subcutaneous emphysema.[8],[9] Furthermore, PONV is a leading cause of unexpected hospital admission and increased total health-care costs.[10],[11] Equally important is the high levels of patient discomfort and dissatisfaction associated with PONV. It is assumed that PONV has multifactorial origin, for instance, esthetic factors (such as volatile anesthetics, mask ventilation, or opioids), patient-related factors (history of motion sickness or female gender), and surgical factors.[12],[13]

Because of the reduced attention to nausea and vomiting occurring after surgical anesthesia, this epidemiologic survey was designed to evaluate the present incidence of PONV for different types of common surgical procedures at Tripoli Medical Center, Tripoli, Libya.


  Methods Top


This study was designated as a prospective interview-based investigation of the occurrence of PONV. To attain an illustrative sample of everyday surgery, we collected records from 170 patients attending several types of surgical procedures in different operating theaters: general surgery, gynecological, orthopedics, and ophthalmological at Tripoli Medical Center, Tripoli, Libya. Enrollment and interviewing of patients were conducted from the beginning from November 2017 to April 2018. This study was approved by the Committee of Faculty of Medical technology, Tripoli University, Libya.

Inpatients arranged to undergo elective surgery from one of the surgical procedures requiring anesthesia (general or regional) and follow-up for the first 2 h in the recovery room were enrolled in this study. Patients from both genders but pregnant patients and those requiring management in the intensive care unit were not included in the study. All patients during the study who met the inclusion criteria entered the study, and patient consent was obtained. Anesthesia staff instructed to use the usual anesthesia technique and postanesthetic care.

All relevant data recorded in the data collection were analyzed using Microsoft Excel 2013 and SPSS version 22. 0 (SPSS Inc., Chicago, IL). Descriptive statistics (such as frequencies and percentages) were used to analyze the data. Comparing the incidences of PONV with different surgical procedures were analyzed using the ANOVA test. Data comparison between PONV prevalence and anesthesia techniques was done using Student's t-test.


  Results Top


Patient characteristics

Questioners and interviews were completed for 170 patients, of whom, 108 (63.5%) were female. The distribution of the inpatient within the four surgical departments and different procedures is shown in [Table 1].
Table 1: Number (%) of different types of procedures by gender

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[Table 2] presents demographic characteristics of the patients for different types of surgery and anesthesia. The anesthetic technique was general in 152 (89.4%) patients and 18 (10.6%) was regional anesthesia (RA). In RA groups, the proportion of female was greater than general anesthesia (GA) group (134 vs. 94), in which the patients were generally younger. Other characteristics in both anesthesia groups were quite similar.
Table 2: Demographic data of the patients for the different types of surgery and anesthesia

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Male and female patients were equally similar with regard to age and preoperative condition, apart from some difference in the following assumed prognostic factors for PONV; the proportions of female with PONV after the previous general and RA were 47% and 12%, respectively, and those of male 26% and 8%, respectively; 23% of males were regular smokers.

Each patient received intraoperative opioids (fentanyl in most cases). Enhancement boluses of fentanyl were given as required. Postoperative pain was treated with intramuscular or intravenous opioid (tramadol) in 60% of patients and with epidural opioids in 19% of patients. Opioids were used less after otolaryngology operations than after other types of surgery and less after regional than GA [Table 2]. Further, 31% of all patients received only nonsteroidal anti-inflammatory drugs for pain relief.

Emetic outcomes related to surgery

During the first 2 h after surgery, nausea was experienced by 28.2% of all patients and 22.3% vomited. Significantly, the highest incidence of nausea was reported in gynecology patients, of whom 62.5% were treated with antiemetic medication [Table 3] (P < 0.05).
Table 3: The percentage of patients with nausea and vomiting and administration of antiemetics in different type of surgery

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During the second observation period from 2 to 24 h postoperatively, the proportions of patients with nausea and vomiting in the whole population were 32.3% and 25.8%, respectively. Again, the rates were significantly higher in the gynecology patients (nausea – 68.7% and vomiting – 50%), followed by orthopedic surgery patients [Table 3]. Vomiting was treated with antiemetics more often than nausea only.

Emetic outcomes by anesthesia

Nausea, in the recovery room, was more common after GA compared with RA (36.8% and 27.7%, respectively, P < 0.05) [Table 3]. Similarly, in the ward, the incidence of nausea was higher in GA than regional technique (40.7% and 22%, respectively). Female patients suffered more from nausea than male patients. The incidence of vomiting both, in the recovery room and on the ward, was higher in GA than regional one (24.3% and 26.3% in GA and 11% and 16.6% in RA, respectively, P < 0.05) [Table 4]. Again, female patients were suffered from vomiting more than male patients.
Table 4: The percentage of patients with nausea and vomiting and administration of antiemetics in different type of anesthesia

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  Discussion Top


This survey was conducted to examine the occurrence of PONV. PONV remains one of the most frequent anesthesia-related problems, touching about 30% of patients after surgery, and with an frequency reaching up to 80% in high-risk patients.[14],[15] The main cause of PONV remains blurred but includes anesthetic and surgical influences. In addition to patient dissatisfaction, PONV may also lead to more serious complications, such as adverse surgical consequences.[14]

Particular attention was given to the type of surgery. Certainly, there is a connection between PONV and the operation type. However, its fundamental impact on PONV is still questionable because a high occurrence of PONV next certain procedures might be induced by the involvement of high-risk patients (e.g., in gynecologic laparotomies, the patients are females and are also probably receive postoperative opioids).[6],[16] In our survey, the highest incidence of nausea and vomiting was in gynecology cases and the lowest incidence stated in otolaryngology patients, which is consistent with other previous studies.[5],[7]

The importance of female gender is well established and appears as the most significant factor of PONV.[13],[17],[18] Our results approved that, nausea and vomiting in female patients were higher than male patients, this is in occurrence with previous surveys.[5],[18] Moreover, our findings showed that 152 (89.4%) of patients were anesthetized by GA techniques, which known to trigger more emetic reaction than RA does. This may have raised the overall prevalence of PONV even though the anesthetic technique used was illustrative of existing practice elsewhere.[13],[19]

In the present study, the occurrence of nausea and vomiting after RA was similar to that reported by Carpenter et al.[20] However, our sample size in this study was too small to dismiss the chance difference. The practice of using opioids and other sedatives in association with some regional blocks may also have contributed to the high rate of nausea in these patients. The incidence of PONV can be reduced by giving prophylaxis medicines, less emetogenic anesthetic techniques, appropriate pain control, good antiemetic drugs, and less invasive surgical processes.[6],[21]


  Conclusion Top


Our survey is upgraded our awareness of postoperative complication and increased the possibility of recognizing patients at risk for PONV, using a small number of simple individual characteristics. Furthermore, this survey is clinically important for prophylaxis and treatment of the two symptoms and possibly will influence how upcoming efforts in this area are done.

Acknowledgment

We are grateful for all the anesthesiologist, anesthesia technician, and students elaborated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Bhakta P, Ghosh BR, Singh U, Govind PS, Gupta A, Kapoor KS, et al. Incidence of postoperative nausea and vomiting following gynecological laparoscopy: A comparison of standard anesthetic technique and propofol infusion. Acta Anaesthesiol Taiwan 2016;54:108-13.  Back to cited text no. 6
    
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Smith HS, Smith EJ, Smith BR. Postoperative nausea and vomiting. Ann Palliat Med 2012;1:94-102.  Back to cited text no. 8
    
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Kwak KH. PONV prevention: Still not enough. Korean J Anesthesiol 2017;70:489-90.  Back to cited text no. 9
    
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Dobbeleir M, De Coster J, Coucke W, Politis C. Postoperative nausea and vomiting after oral and maxillofacial surgery: A prospective study. Int J Oral Maxillofac Surg 2018;47:721-5.  Back to cited text no. 13
    
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Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113.  Back to cited text no. 15
    
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Camu F, Lauwers MH, Verbessem D. Incidence and aetiology of postoperative nausea and vomiting. Eur J Anaesthesiol Suppl 1992;6:25-31.  Back to cited text no. 16
    
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Champion S, Zieger L, Hemery C. Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study. Ann Card Anaesth 2018;21:8-14.  Back to cited text no. 18
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Pierre S, Whelan R. Nausea and vomiting after surgery. Contin Educ Anaesth Crit Care Pain 2013;13:28-32.  Back to cited text no. 19
    
20.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906-16.  Back to cited text no. 20
    
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Haigh CG, Kaplan LA, Durham JM, Dupeyron JP, Harmer M, Kenny GN. Nausea and vomiting after gynaecological surgery: A meta-analysis of factors affecting their incidence. Br J Anaesth 1993;71:517-22.  Back to cited text no. 21
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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