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Risk Assessment of Postoperative Nausea and Vomiting in the Intravenous Patient-Controlled Analgesia Environment: Predictive Values of the Apfel's Simplified Risk Score for Identification of High-Risk Patients

 Shin Hyung Kim  ;  Yang-Sik Shin  ;  Young Jun Oh  ;  Jeong Rim Lee  ;  Sung Chan Chung  ;  Yong Seon Choi 
 YONSEI MEDICAL JOURNAL, Vol.54(5) : 1273-1281, 2013 
Journal Title
Issue Date
Adult ; Analgesia, Patient-Controlled/adverse effects* ; Anesthetics, Intravenous/administration & dosage ; Anesthetics, Intravenous/adverse effects ; Anesthetics, Intravenous/therapeutic use ; Antiemetics/administration & dosage ; Antiemetics/therapeutic use ; Female ; Fentanyl/administration & dosage ; Fentanyl/adverse effects ; Fentanyl/therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postoperative Nausea and Vomiting/drug therapy* ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors
Apfel’s simplified risk score ; patient-controlled analgesia ; postoperative nausea and vomiting
PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS: We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS: In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION: Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Shin, Yang Sik(신양식)
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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