Running head: REDUCING THE INCIDENCE OF POSTOPERATIVE NAUSEA AND
Reducing the Incidence of Postoperative Nausea and Vomiting
in the Ambulatory Surgical Patient
Susan Cody
National University
Public Health Research Design
COH 611
Dr. Robert Clegg
March 24, 2015
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REDUCING THE INCIDENCE OF POSTOPERATIVE NAUSEA AND
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Reducing the Incidence of Postoperative Nausea and Vomiting
in the Ambulatory Surgical Patient
Postoperative nausea and vomiting (PONV) are common, and very distressing to patients.
The incidence of nausea is about 50%, and of vomiting, about 30%. In some patients, this
incidence is up to 80%, depending on other health factors. PONV can result in longer stays in the
Post Anesthesia Care Unit (PACU), or a readmission to the hospital, both of which increase
healthcare costs. Using PONV prophylaxis is the key to reducing stress to the patient, as well as
controlling healthcare costs.
The purpose of this study would be to determine the best antiemetic medication, or
combination thereof, to reduce the incidence of PONV for those patients receiving general
anesthesia. This study is also involving those patients who are discharged from hospital the same
day as their surgery. It is felt that these patients would be able to report their symptoms, or lack
of symptoms, more readily and accurately than those who continue to be hospitalized. Those
patients who have been hospitalized would most likely be receiving large and frequent doses of
narcotic pain relievers, thereby decreasing their ability to report their symptoms immediately
postop.
Literature from various specialty groups has been examined. Those include the Society
for Ambulatory Anesthesia, The Journal of Alternative and Complementary Medicine, the
Journal of Clinical Anesthesia, and the Cochrane Collaboration. This literature covers a wide
variety of antiemetic therapy, including standard medications, aromatherapy, and other
alternative therapies. Anesthesia guidelines for practice had been established in 2003 and 2007.
New guidelines were developed in 2014 based on research from those previous studies, as well
as extensive literature searches from several hundred publications on PONV. The new updates
REDUCING THE INCIDENCE OF POSTOPERATIVE NAUSEA AND
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include information on risk factors and a rick scoring system for post-discharge nausea and
vomiting, new antiemetics such as Nerokinin-1 receptor antagonists, the efficacy of existing
antiemetics, and recommendations of new combinations of medications. Also discussed were
strategies for multimodal approaches in adults and children to prevent PONV. The goal of
current guidelines is to provide current and comprehensive information for practicing
anesthesiologists, nurse anesthetists, pharmacists and other healthcare providers. (Gan et al.,
2014)
Other literature discussed the use of aromatherapy for the treatment of nausea as a means
to control costs, and to provide a treatment when other treatments have failed or can cause
adverse side effects. The study was conducted using a placebo of saline solution, and the use of
isopropyl alcohol vapor inhalation. It was found that the use of alcohol vapor reduced nausea in
some patients, but concluded that large-scale randomized controlled trials would be needed to
definitively conclude benefit or lack thereof. (Hines, Steels, Chang, & Gibbons, 2012)
Another article addressed the use of herbal supplements to decrease or eliminate PONV.
Using a Kampo medicine in a single-blind, randomized trial, a study was conducted on women
having laparoscopic surgery to determine whether there was any improvement in symptoms.
Kampo is a separate system of herbal combinations, forms of acupuncture, and moxibustion.
Kampo has a vibrant history of books and manuscripts written by experts about this form of
medicine; the published history of Kampo spans ancient times till today. One practice is
moxibustion, which is the burning of herbs on or near acupuncture points. Kampo uses this
method more than TCM. The role of moxibustion in Kampo has grown in importance, and the
government now issues a license just for moxibustion over acupuncture points. In this instance,
one group of patients was given an herbal preparation,named GRS, the day before surgery, and
REDUCING THE INCIDENCE OF POSTOPERATIVE NAUSEA AND
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another group was administered a placebo. Results found that administering the herbal
preparation significantly reduced the severity of PONV. (Kori et al., 2013)
Null hypothesis is that there is significant relief in postoperative nausea and vomiting
with the use of antiemetics before, during, and after surgery.
The sample use will be postoperative, ambulatory patients that were discharged from
hospital on the same day as their procedure. The participants will be contacted by phone call one
day and seven days post procedure, and queried as to the incidence of nausea and/or vomiting
within 12 and 24 hours postop, and for the period of 3-7 days post procedure. The study will not
be limited by age, gender, but there will be notation of procedure. A questionnaire will be
utilized to collect responses, which will then be reviewed to determine results.
Data will be categorized according to procedure and anesthesia type, as well as if any
pre-medications were administered. Also documented will be additional medications in PACU or
the Ambulatory Surgery Department that were required for PONV. This information will be
collected from the patient’s medical record. Additional information from the postop phone calls
will be documented during those calls. This information will be whether the patient experienced
any nausea or vomiting immediately post procedure, during their PACU stay, during the
Ambulatory Surgery phase, or after discharge from hospital.
The participant’s identities will remain strictly confidential. No personal information will
be recorded. Information will be collected via the electronic hospital record, and from the postop
phone call. Identifying information will only pertain to surgical procedure, age, type of
anesthesia, and types of antiemetic medications administered.
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References
Gan, T., Diemunsch, P., Habib, A., Kovak, A., Kranke, P., Meyer, T., Tramer, M. (January,
2014). Consensus Guidelines for the Management of Postoperative Nausea and
Vomiting. Society for Ambulatory Anesthesiology, 118(1), 85-113. Retrieved from
http://journals.lww.com/anesthesiaanalgesia/Fulltext/2014/01000/Consensus_Guidelines_for_the_Management_of.13.aspx
Newsom, Cresilda T. (2014) Aromatherapy for treatment of postoperative nausea and vomiting.
Cochrane Database of Systematic Reviews. Retrieved from
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Kori, K., Oikawa, T., Odaguchi, H., Omoto, H., Hanawa, T., & Minami, T. (2013). Go-rei-San, a
Kampo Medicine, Reduces Postoperative nausea and vomiting: A prosepctive, singleblind, randomized trial. The Journal of alternative and complementary medicine, 19(12),
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Clinical Anesthesia, 25(7), 551-559. Retrieved from
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