title: Preoperative fasting before interventional techniques: is it necessary or evidence-based?
abstract: BACKGROUND
  Interventional pain management is an evolving specialty. Multiple issues including preoperative fasting, sedation, and infection control have not been well investigated and addressed. Based on the necessity for sedation and also the adverse events related to interventional techniques, preoperative fasting is considered practical to avoid postoperative nausea and vomiting. However, there are no guidelines for interventional techniques for sedation or fasting. Most interventional techniques are performed under intravenous or conscious sedation.
  
  
  OBJECTIVE
  To assess the need for preoperative fasting and risks without fasting in patients undergoing interventional techniques.
  
  
  METHODS
  A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009.
  
  
  METHODS
  An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
  
  
  METHODS
  All patients presenting for interventional techniques from May 2008 to December 2009 are included with documentation of various complications related to interventional techniques including nausea and vomiting.
  
  
  RESULTS
  From May 2008 to December 2009 a total of 3,179 patients underwent 12,000 encounters with 18,472 procedures, with patients receiving sedation during 11,856 encounters. Only 189, or 1.6% of the patients complained of nausea and 3 of them, or 0.02%, experienced vomiting. There were no aspirations. Of the 189 patients with nausea, 80 of them improved significantly prior to discharge without further complaints. Overall, 109 patients, or 0.9% were minimally nauseated prior to discharge. The postoperative complaints of continued nausea were reported in only 26 patients for 6 to 72 hours. There were only 2 events of respiratory depression, which were managed with brief oxygenation with mask without any adverse consequence of nausea, vomiting, aspiration, or other adverse effects.
  
  
  CONCLUSIONS
  Limitations include the nonrandomized observational nature of the study.
  
  
  CONCLUSIONS
  This study illustrates that postoperative nausea, vomiting, and respiratory depression are extremely rare and aspiration is almost nonexistent, despite almost all of the patients receiving sedation and without preoperative fasting prior to provision of the interventional techniques.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Malla
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Wargo
authors.forename: Bert
authors.initials: B
authors.lastname: Fellows
mesh_terms: D000328:Adult; D000368:Aged; D019317:Evidence-Based Medicine; D005215:Fasting / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000517:prevention & control; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D012120:Respiration Disorders / Q000517:prevention & control; D012189:Retrospective Studies; D014481:United States; D014839:Vomiting / Q000517:prevention & control