Postoperative nausea management and patient-controlled analgesia.
Following the establishment of an acute pain service in one UK acute NHS trust, including the introduction of patient-controlled analgesia (PCA), pain scoring, and a rationalization of the use of simple analgesics, attention was drawn to an apparent increase in postoperative nausea and vomiting (PONV) among women given PCA following abdominal hysterectomy. Audits were conducted into clinical practice and patient satisfaction and it was agreed that an evaluation of the evidence should be conducted to ensure that the correct direction for development in the management of PONV could be established. This article discusses the evidence surrounding the issues regarding the management of PONV in patients who have been given PCA. The possibility of adding antiemetics to the analgesic solution, and the choice of antiemetic drugs, are investigated. Other factors that can affect the incidence of PONV in patients with PCA are also discussed, and an auditable framework for the evaluation of clinically effective practice is suggested.
Bibby
P F
PF
University of Sheffield, Doncaster and Bassettlaw Hospitals, NHS Trust, UK.
D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000379:methods*; D000932:Antiemetics / Q000627:therapeutic use*; D002985:Clinical Protocols; D003501:Cyclizine / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D009731:Nursing Audit; D017294:Ondansetron / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors
D000932:Antiemetics; D017294:Ondansetron; D003501:Cyclizine