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AMBULATORY ANESTHESIOLOGY

Routine Use of Nasogastric Tubes Does Not Reduce Postoperative Nausea and Vomiting

Karl-Heinz Kerger^*, Edward Mascha, Britta Steinbrecher, Thomas Frietsch, Oliver C. Radke^||¶, Katrin Stoecklein^#, Christian Frenkel^**, Georg Fritz, Klaus Danner, Alparslan Turan, Christian C. Apfel, MD, PhD^|| For the IMPACT Investigators

From the *Department of Anesthesiology and Critical Care Medicine, Evangelian Deaconry Hospital, Freiburg, Germany; Department of Anesthesiology and Operative Critical Care Medicine, University Hospital Mannheim, Mannheim, Germany; Departments of Quantitative Health Sciences, and Outcomes Research, Cleveland Clinic, Cleveland, Ohio; Westpfalz-Klinikum GmbH, Kaiserslautern, Germany; ||Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, University of California at San Francisco, UCSF Medical Center at Mount Zion, San Francisco, California; ¶Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, University Hospital Dresden, Dresden, Germany; #Department of Anesthesiology, VU University medical center, Amsterdam, The Netherlands; **Städtisches Klinikum Lüneburg gemeinnützige GmbH, Lüneburg, Germany; Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Heart Centre Brandenburg at Bernau, Bernau, Germany; Department of Anaesthesiology, Trakya University, Edirne, Turkey; and The Outcomes Research Consortium, Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky.

Address correspondence and reprint requests to Christian C. Apfel, MD, PhD, Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), UCSF Medical Center at Mount Zion, 1600 Divisadero, C-447, San Francisco, CA 94115. Address e-mail to apfel{at}ponv.org or apfelc{at}anesthesia.ucsf.edu.

Abstract

Routine use of a nasogastric (NG) tube has been suggested to prevent postoperative nausea and vomiting (PONV) despite conflicting data. Accordingly, we tested the hypothesis that routine use of a NG tube does not reduce PONV.

Our work is based on data from a large trial of 4055 patients initially designed to quantify the effectiveness of combinations of antiemetic treatments for the prevention of PONV. This analysis uses propensity scores for case matching to ensure group comparability on baseline factors. Intraoperative NG tube use patients and perioperative NG tube use patients were respectively matched to nonuse patients on all available potential confounders.

Matched-pairs were identified using propensity scores for 1032 patients with or without intraoperative NG tube use and 176 patients with or without perioperative NG tube use. The incidences of PONV in the intraoperative group were 44.4% vs 41.5% (P = 0.35) with and without tube use, respectively, and 27.8% vs 31.3% (P = 0.61) in the perioperative group.

Our results provide evidence that routine use of a NG tube does not reduce the incidence of PONV.