title: Nausea, vomiting, sleep, and restfulness upon discharge home after outpatient anterior cruciate ligament reconstruction with regional anesthesia and multimodal analgesia/antiemesis.
abstract: OBJECTIVE
  We analyzed discharge outcome data after anterior cruciate ligament reconstruction (ACLR) under spinal anesthesia including a perineural femoral catheter and multimodal analgesia/antiemesis. The outcomes specifically addressed in this report are nausea, vomiting, and retching (NVR) and quality of sleep/difficulty falling asleep/daytime restfulness.
  
  
  METHODS
  ACLR patients were randomized to saline or 0.25% levobupivacaine as a bolus and/or 50-hour infusion. Patients completed the Quality of Recovery 40-item (QoR-40) survey on postoperative days 1 to 4. We analyzed predictors of perfect responses (i.e., no NVR and perfect sleep-restfulness) by pooling these specific QoR-40 items. Prospectively collected QoR-40 data were analyzed retrospectively.
  
  
  RESULTS
  Data from 233 participants were analyzed. The addition of the femoral nerve block or perineural catheter did not predict associated improvements in NVR or sleep-restfulness. Previous days' NVR was the most consistent predictor of subsequent NVR, whereas gender and opioid consumption were less consistent predictors. Smoking status was not predictive of NVR. Previous days' sleep-restfulness was a consistent predictor of subsequent sleep-restfulness, whereas the presence of any moderate pain was a less consistent predictor of sleep-restfulness.
  
  
  CONCLUSIONS
  NVR and quality of sleep-restfulness after the described regional anesthetic with multimodal analgesia and antiemesis is reported. Smoking status was not a predictor of NVR, and gender and opioid consumption were not consistently predictive of NVR. The addition of a femoral nerve block to the described multimodal technique was not associated with NVR or quality of sleep-restfulness.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Williams
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kentor
authors.forename: James J
authors.initials: JJ
authors.lastname: Irrgang
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bottegal
authors.forename: John P
authors.initials: JP
authors.lastname: Williams
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000932:Antiemetics / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D000077554:Levobupivacaine; D016015:Logistic Models; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017847:Patellar Ligament / Q000637:transplantation; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D012189:Retrospective Studies; D012890:Sleep / Q000187:drug effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics; D000077554:Levobupivacaine; D002045:Bupivacaine