title: Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting.
abstract: OBJECTIVE
  To assess the prevalence of postdischarge nausea and vomiting (PDNV) after Le Fort I osteotomy with and without the use of a multimodal antiemetic protocol shown to decrease postoperative nausea and vomiting (PONV).
  
  
  METHODS
  Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution formed the intervention cohort for an institutional review board-approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol. The comparison group consisted of consecutive patients who underwent similar surgical procedures at the same institution before protocol implementation. All patients were asked to complete a postdischarge diary documenting the occurrence of nausea and vomiting. Those who completed the diaries were included in this analysis. Data were analyzed with the Fisher exact test and the Wilcoxon rank sum test. A P value less than .05 was considered significant.
  
  
  RESULTS
  Diaries were completed by 85% of patients in the intervention group (79 of 93) and 75% of patients in the comparison group (103 of 137). Patients in the intervention (n = 79) and comparison (n = 103) groups were similar in the proportion of patients with validated risk factors for PDNV, including female gender, history of PONV, age younger than 50 years, opioid use in the postanesthesia care unit (PACU), and nausea in the PACU (P = .37). The prevalence of PDNV was unaffected by the antiemetic protocol. After discharge, nausea was reported by 72% of patients in the intervention group and 60% of patients in the comparison group (P = .13) and vomiting was reported by 22% of patients in the intervention group and 29% of patients in the comparison group (P = .40).
  
  
  CONCLUSIONS
  Modalities that successfully address PONV after Le Fort I osteotomy might fail to affect PDNV, which is prevalent in this population. Future investigation will focus on methods to minimize PDNV.
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC.
authors.forename: Carolyn Dicus
authors.initials: CD
authors.lastname: Brookes
authors.affiliation: Professor and Chairman, Department of Oral and Maxillofacial Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Turvey
authors.affiliation: Professor, Department of Orthodontics, University of North Carolina-Chapel Hill, Chapel Hill, NC.
authors.forename: Ceib
authors.initials: C
authors.lastname: Phillips
authors.affiliation: Professor, Department of Anesthesiology, University of North Carolina-Chapel Hill, Chapel Hill, NC.
authors.forename: Vincent
authors.initials: V
authors.lastname: Kopp
authors.affiliation: Associate Professor, Departments of Anesthesiology and Oral and Maxillofacial Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC. Electronic address: janderson@aims.unc.edu.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000762:Anesthesia Recovery Period; D000932:Antiemetics / Q000627:therapeutic use*; D015331:Cohort Studies; D004155:Diphenhydramine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D017294:Ondansetron / Q000627:therapeutic use; D019340:Osteotomy, Le Fort / Q000379:methods*; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000209:etiology* / Q000517:prevention & control; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000932:Antiemetics; D009294:Narcotics; D011412:Propanolamines; D017294:Ondansetron; D004155:Diphenhydramine; C036604:esmolol