The effect of perioperative esmolol infusion on the postoperative pain and nausea vomiting after middle ear surgeries

2021 ◽  
Vol 19 (3) ◽  
pp. 60-64
Author(s):  
Payal P Adhiya ◽  
Keyword(s):  
Postoperative Pain ◽  
Middle Ear ◽  
Postoperative Nausea ◽  
Beta Blockers ◽  
Postoperative Nausea And Vomiting ◽  
Loading Dose ◽  
Hemodynamic Stability ◽  
Saline Loading ◽  
Background Pain ◽  
C 30

Background: Pain and postoperative nausea and vomiting are the most common postoperative complications in middle ear surgeries. Amongst the beta-blockers, esmolol is ultrashort acting cardio selective β1 receptor antagonist used for management of postoperative pain. It also contributes to the significant decrease in PONV and reduces patient distress and facilitates earlier discharge. Objective: To evaluate the effectiveness of perioperative esmolol infusion on postoperative pain relief and postoperative nausea vomiting after middle ear surgeries. Methods: After obtaining approval from Institution Ethics Committee, 70 patients of age 15 and 65 years of ASA I,II and III were allocated with randomization into two groups of 35 each. Group C: 30 ml normal saline loading dose and thereafter continuous infusion of 1ml/min and Group E:0.5mg/kg esmolol in 30ml NS loading dose and 30ug/kg/min as infusion. Results: Average duration of analgesia was about 535 min in group E as compared to 187 min in group C. For PONV requirement of inj. ondansetron in group E was after 145 min and in group C it was 20 min. Group E patients had significantly less variations in blood pressure and heart rate intraoperatively and the response to intubation was masked as compared to group C. Conclusion: Intraoperative esmolol infusion is a newer justified method to reduce postoperative pain and PONV with advantage of hemodynamic stability.

Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery

2018 ◽  
Vol 29 (6) ◽  
pp. 606-614 ◽  
Author(s):  
Jean-Baptiste Ducloyer ◽  
Chloé Couret ◽  
Cécile Magne ◽  
Corinne Lejus-Bourdeau ◽  
Michel Weber ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Ophthalmic Surgery ◽  
Oculocardiac Reflex ◽  
Locoregional Anesthesia ◽  
The Mean ◽  
Congenital Cataract Surgery

Purpose: To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac reflex, postoperative nausea and vomiting, and postoperative pain. Methods: This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron. No drug-based prevention of oculocardiac reflex or local/locoregional anesthesia was employed. Results: A total of 106 pediatric ophthalmic surgeries completed between November 2015 and May 2016 were analyzed. The mean patient age was 4.4 (range: 0.2–7.3, standard deviation: 2.4) years. Ambulatory rate was 90%. Oculocardiac reflex incidence was 65% during strabismus surgery (34/52), 50% during congenital cataract surgery (4/8), 33% during intramuscular injection of botulinum toxin (1/3), and 0% during other procedures. No asystole occurred. Postoperative nausea and vomiting incidence was 9.6% after strabismus surgery (5/52) and 0% following the other procedures. One child was hospitalized for one night because of persistent postoperative nausea and vomiting. Postoperative pain generally occurred early on in the recovery room and was quickly controlled. Its incidence was higher in patients who underwent strabismus surgery (27%) than in those who underwent other procedures (9%). Conclusion: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented.

scholarly journals Efficacy of Three Different Prophylactic Treatments for Postoperative Nausea and Vomiting after Vitrectomy: A Randomized Clinical Trial

2019 ◽  
Vol 8 (3) ◽  
pp. 391 ◽  
Author(s):  
Michele Reibaldi ◽  
Matteo Fallico ◽  
Antonio Longo ◽  
Teresio Avitabile ◽  
Marinella Astuto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Adverse Events ◽  
Local Anesthesia ◽  
Postoperative Nausea ◽  
Therapy Group ◽  
Combined Therapy ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Combination Group

Postoperative nausea and vomiting (PONV) after vitreoretinal surgery may potentially be associated with severe complications, such as suprachoroidal hemorrhage. The purpose of the present multicenter clinical trial (NCT02386059) was to assess the efficacy of three different prophylactic treatments for PONV after vitrectomy under local anesthesia. Patients undergoing primary vitrectomy were randomized to the control arm or to one of the treatment arms (4 mg ondansetron, 4 mg dexamethasone, combination of the two drugs). The primary outcome measure was the proportion of complete response (no nausea, no vomiting, no retching, and no use of antiemetic rescue medication) during 24 h after vitrectomy. Secondary outcomes included the severity standardized score of PONV, postoperative pain standardized score, and rate of ocular and non-ocular adverse events. Baseline demographics of the 1287 patients were comparable between the four arms. The combined therapy group showed a statistically significant lower incidence of PONV compared to the placebo and monotherapy (p < 0.001). PONV severity was also reduced in the combination group compared to the others (p < 0.001). Postoperative pain scores and adverse events were comparable among the four groups. Combined therapy with dexamethasone and ondansetron was the most effective treatment for reducing the incidence and severity of PONV in patients undergoing vitrectomy under local anesthesia.

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