Anesth Analg 2008; 107:344-
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181771060
LETTER TO THE EDITOR
Section Editor:
: Lawrence Saidman
Smoking and Nalbuphine May Reduce Postoperative Emesis
Seza Apiliogullari, MD, and
Ates Duman, MD
Department of Anaesthesia and Intensive Care; Dr. Faruk Sukan Obstetrics and Children Hospital; sapiliogullari{at}yahoo.com (Apiliogullari)
Department of Anaesthesia and Intensive Care; Selcuk University Medical Faculty; Konya, Turkey (Apiliogullari)
To the Editor:
Harnett et al.1 concluded that overall rates for emesis were reduced by one-third by prophylactic transdermal scopolamine or ondansetron (59% vs 40% and 41.8%, respectively). This small difference shows the need for meticulous planning for RCTs, especially for studies assessing the rate of postoperative nausea and vomiting (PONV) that may be influenced by numerous factors such as smoking, various medications, postoperative opioids, and combinations of these factors.2 Recently, Ionescu et al.3 reported that emesis was reduced by one-third in cigarette smokers, an important factor not mentioned in the patient demographics of this study.
Rescue medications in the study also have the potential to influence the results. Ondansetron used as a rescue antiemetic in the placebo or scopolamine group may have a prophylactic effect on late results.4,5 In addition, nalbuphine an agonist– antagonist opioid effective in the treatment of emesis caused by neuroaxial opioids6 was used in more than 30% of patients and may have affected the overall rate of PONV in all groups.
REFERENCES
- Harnett MJ, O'Rourke N, Walsh M, Carabuena JM, Segal S. Transdermal scopolamine for prevention of intrathecal morphine-induced nausea and vomiting after cesarean delivery. Anesth Analg 2007;105:764–9[Abstract/Free Full Text]
- Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;9:693–700
- Ionescu D, Badescu C, Acalovschi I. Nicotine patch for the prevention of postoperative nausea and vomiting: a prospective randomised trial. Clin Drug Investig 2007;27:559–64[Medline]
- Peixoto AJ, Celich MF, Zardo L, Peixoto Filho AJ. Ondansetron or droperidol for prophylaxis of nausea and vomiting after intrathecal morphine. Eur J Anaesthesiol 2006;23:670–5[Web of Science][Medline]
- Yazigi A, Chalhoub V, Madi-Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanil-morphine. J Clin Anesth 2002;14:183–6[Web of Science][Medline]
- Wang JJ, Ho ST, Tzeng JI. Comparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects. Reg Anesth Pain Med 1998;23:479–84[Web of Science][Medline]
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M. Harnett and S. Segal
Smoking and Nalbuphine May Reduce Postoperative Emesis
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344 - 344.
[Full Text]
[PDF]
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