From Health Sciences Center - University of Louisville

Med School News
U OF L RESEARCHERS' WORK IN PREVENTION OF POST-OPERATIVE NAUSEA AND VOMITING PUBLISHED IN NEW ENGLAND JOURNAL OF MEDICINE

Jun 9, 2004

            LOUISVILLE, Ky. — A study led by University of Louisville researchers and published in the June 10 edition of The New England Journal of Medicine recommends a common-sense approach to prevention of post-operative nausea and vomiting (PONV).

 

            According to study author Dr. Christian Apfel, more than 20 million people experience severe nausea or vomiting after surgery each year at an annual cost in the United States of more than $200 million. PONV can cause a host of complications for the patient and is the leading cause of unplanned hospital admissions following outpatient surgery.

 

            “Although several trials had been conducted, the relative benefits of preventive anti-vomiting interventions remained unknown,” Apfel explained. “Our study is by far the largest randomized controlled trial for the prevention of post-operative nausea and vomiting.”

 

            Apfel, an assistant professor of anesthesiology, led a team of research physicians at 28 participating centers to study the relative benefits of preventative anti-nausea therapies in more than 5,000 research participants. Each participant was randomly assigned to receive one of many predetermined combinations of six anti-vomiting approaches and was then evaluated for nausea and vomiting within 24 hours after surgery.

 

            The authors found that each approach reduced the risk of nausea and vomiting after surgery by about 25 percent. Combinations of two approaches were more effective than any single approach. The absolute reduction rate depends mainly on the initial patient’s risk, which can be measured with a pre-operative risk assessment.

 

            Several risk factors increase the chance that a patient will experience PONV. For example, women and nonsmokers are more likely to experience PONV, as are individuals with a history of motion sickness, a history of post-operative nausea and vomiting or patients who require use of post-operative opioids. Each factor increases risk for PONV by 20 percent.

 

            “We found that, since each of four interventions reduced the risk of symptoms equally, the least expensive or the safest approach for that patient should be used first,” said co-author Dr. Daniel Sessler, professor of anesthesiology and vice dean for research. “In patients with low risk, preventive anti-vomiting therapies are unnecessary, whereas multiple interventions may be most helpful for those at high risk.”

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