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Disturbing postoperative symptoms are not reduced by prophylactic antiemetric treatment in patients at high risk for post-operative nausea and vomiting
Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
Department of Anesthesiology, Västervik Hospital, Sweden.
Department of Anesthesiology, Västervik Hospital, Sweden.
Department of Anesthesiology, Västervik Hospital, Sweden.
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2004 (English)In: Acta anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 48, no 6, 761-71 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To give prophylactics or timely treatment for post-operative nausea and vomiting (PONV) is the question. We compared the intensity and number of disturbing post-operative symptoms (i.e. pain, PONV, headache, fatigue, etc.) after prophylactic antiemetic treatment in a group of patients with >30% risk for post-operative vomiting. METHODS: Four hundred and ninety-five patients, from three hospitals, planned for gynaecological surgery were randomized double blind. They were given granisetron 3 mg, droperidol 1.25 mg or no prophylactic antiemetic. Post-operative symptoms were followed for 24 h using a questionnaire. Symptoms were analyzed both according to their intensity and in a dichotomous fashion. RESULTS: The intensity of different symptoms differed depending on whether droperidol, granisetron or no antiemetic had been given (P = 0.005) but the overall incidence of moderate to very severe symptoms was similar in all groups. No group fared better in general. The total number of symptoms was higher in the groups given prophylactic treatment (P < 0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis was 27%[95% confidence interval (CI) 8-43] and 22% (2-38), respectively. The NNT (number needed to treat) for granisetron (0-24 h) was 7 and for droperidol 8. The NNH (number needed to harm) (0-24 h) for headache and visual disturbances was 6 and 13 (NS) for granisteron and, 50 (NS) and 6 for droperidol. CONCLUSION: The intensity of symptoms or the total number of disturbing symptoms did not decrease after prophylactic antiemetic treatment in a group of patients, but the profile of disturbing symptoms changed. The relevance of post-operative symptoms in terms of patients' well-being needs to be addressed.

Place, publisher, year, edition, pages
2004. Vol. 48, no 6, 761-71 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13650DOI: 10.1111/j.0001-5172.2004.00403.xOAI: oai:DiVA.org:liu-13650DiVA: diva2:21111
Available from: 2004-05-20 Created: 2004-05-20 Last updated: 2009-10-14
In thesis
1. Postoperative Symptoms After Gynaecological Surgery: How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
Open this publication in new window or tab >>Postoperative Symptoms After Gynaecological Surgery: How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness.

Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III).

Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009).

Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2004
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 851
Keyword
Acupuncture, P6-acupressure, droperidol, antiemetics, PONV, gynaecological surgery, motion sickness, eccentric rotation, coriolis effect, antiemetic prophylaxis, granisetron
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-5196 (URN)91-7373-822-0 (ISBN)
Public defence
2004-05-27, Elsa-Brändström salen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Note
On the day of the public defence the status of article IV was: Submitted.Available from: 2004-05-20 Created: 2004-05-20 Last updated: 2009-08-17

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Alkaissi, AidahKalman, Sigga

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