Effects of palonosetron for prophylaxis of postoperative nausea and vomiting in high-risk patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled study

<div><p>Background</p><p>The preemptive multimodal pain protocols used in total knee arthroplasty (TKA) often cause emesis postoperatively. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA.</p><p>Methods</p><p>We randomized 120 female patients undergoing TKA to receive either palonosetron (0.075 mg, intravenous) or no antiemetic prophylaxis (0.9% saline, control group). All patients were given spinal anesthesia, a continuous femoral nerve block, and fentanyl-based intravenous patient controlled analgesia. Patients undergoing staged bilateral TKA were assigned to one group for the first knee and the other group for the second knee. The overall incidence of PONV, the incidences of both nausea and vomiting, severity of nausea, complete response, requirement for rescue antiemetics, pain level, opioid consumption, and satisfaction scores were evaluated during three periods: 0–2, 2–24, and 24–48 h postoperatively. We also compared PONV and pain between the first and second TKA.</p><p>Results</p><p>The incidence of PONV during the first 48 h was lower in the palonosetron group compared with the controls (22 <i>vs</i>. 41%, <i>p</i> = 0.028), especially 2–24 h after surgery, as was the nausea and vomiting respectively. The severity of nausea was lower in the palonosetron group (<i>p</i> = 0.010). The complete response rate (93 <i>vs</i>. 73%, <i>p</i> = 0.016) and satisfaction score (84 ± 12 <i>vs</i>. 79 ± 15, <i>p</i> = 0.032) were higher in the palonosetron group during 2–24 h after surgery. Patients who underwent a second operation complained of more severe pain, and consumed more opioids than those of the first operation. There was no difference in the incidence of PONV between the first and second operations.</p><p>Conclusions</p><p>Palonosetron prophylaxis reduced the incidence and severity of PONV in high-risk patients managed with multimodal pain protocol for 48 h, notably 2–24 h after TKA.</p></div

Complete response rates, requirement of rescue antiemetics, and satisfaction score after surgery.

<p>Complete response rates, requirement of rescue antiemetics, and satisfaction score after surgery.</p

CONSORT flow diagram.

<p>FNB, femoral nerve block.</p

Patients, operative and anesthetic characteristics.

<p>Patients, operative and anesthetic characteristics.</p

Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial

<div><p>Robotic-assisted laparoscopic radical prostatectomy (RARP) needs a steep Trendelenburg position and a relatively high CO₂ insufflation pressure, and patients undergoing RARP are usually elderly. These factors make intraoperative ventilatory care difficult and increase the risk of perioperative pulmonary complications. The aim was to determine the efficacy of recruitment manoeuvre (RM) on perioperative pulmonary complications in elderly patients undergoing RARP. A total of 60 elderly patients scheduled for elective RARP were randomly allocated to two groups after induction of anaesthesia; positive end expiratory pressure (PEEP) was applied during the operation without RM in the control group (group C) and after RM in the recruitment group (group R). The total number of patients who developed intraoperative desaturation or postoperative atelectasis was significantly higher in group C compared to group R (43.3% <i>vs</i>. 17.8%, <i>P</i> = 0.034). Intraoperative respiratory mechanics, perioperative blood gas analysis, and pulmonary function testing did not show differences between the groups. Adding RM to PEEP compared to PEEP alone significantly reduced perioperative pulmonary complications in elderly patients undergoing RARP.</p></div

Patient characteristics and operative data.

<p>Patient characteristics and operative data.</p

Respiratory mechanical parameters at each phase during surgery.

<p>Respiratory mechanical parameters at each phase during surgery.</p

Percent of patients who had complications.

<p>Percent of patients who had complications.</p

Gas exchange parameters at each phase during surgery.

<p>Gas exchange parameters at each phase during surgery.</p

Results of pulmonary function testing.

<p>Results of pulmonary function testing.</p