AANA journal
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Randomized Controlled Trial
A comparative analysis of isopropyl alcohol and ondansetron in the treatment of postoperative nausea and vomiting from the hospital setting to the home.
We compared the efficacy of inhaled isopropyl alcohol (IPA) with ondansetron for the control of postoperative nausea and vomiting (PONV) during a 24-hour period in 100 ASA class I-III women undergoing laparoscopic surgery. Nausea was measured postoperatively using a 0 to 10 verbal numeric rating scale (VNRS). The control group received ondansetron, 4 mg intravenously, and the experimental group inhaled IPA vapors. ⋯ The IPA treatment was successful in alleviating PONV symptoms in the home in 91% of the experimental group. We determined that using IPA after discharge from the postanesthesia care unit is a valuable method to control PONV in the hospital and at home. The results of this study suggest that IPA is much faster than ondansetron for 50% relief of nausea.
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Randomized Controlled Trial
Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk population.
Postoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients. ⋯ The meclizine group had lower VNRS scores in the PACU at 15 (P = .013) and 45 (P = .006) minutes following rescue treatment. The incidence of nausea was lower in the meclizine vs. placebo group (10% vs. 29%) following discharge (P = .038). Prophylactic meclizine resulted in lower incidence and severity of PONV in a high-risk population, especially after rescue treatment.
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Randomized Controlled Trial Comparative Study
Labor epidural anesthetics comparing loss of resistance with air versus saline: does the choice matter?
This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. ⋯ A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.
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Randomized Controlled Trial Comparative Study
Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.
We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure. ⋯ No differences in demographics, block success rate, pain scale scores, and analgesia duration were noted between groups. The ISCM group required less time to complete the block (7.08 +/- 2.9 min) compared with the IS group (9.62 +/- 5.31 min) (P = .039), achieved a significantly higher rate of complete motor and sensory block at 30 minutes (P = .032), and had fewer side effects (P = .049). Based on our results, we found that using the ISCM approach to the brachial plexus resulted in a faster onset of anesthesia and a higher ratio of complete block at 30 minutes compared with the IS approach.
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Randomized Controlled Trial
The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron.
Specific risk factors place patients at greater risk for postoperative nausea and vomiting (PONV). Routinely, these patients are treated prophylactically with intravenous (IV) ondansetron or transdermal (TD) scopolamine. No study has examined what effect using a combination of these prophylactic treatments would have on the incidence of PONV in a group of high-risk patients. ⋯ No difference in demographics or the incidence of side effects was noted between groups. Patients in the scopolamine group had a lower incidence of PONV (P = .043), longer time to first reported nausea (P = .044), longer time to first episode of emesis (P = .031), and decreased supplemental antiemetic requirements (P = .016) compared with the placebo group. Based on this study, we recommend using a combination of TD scopolamine and IV ondansetron to prevent PONV in patients identified as high risk for PONV.