Abstract
Introduction: Incidence of post-operative nausea
and vomiting (PONV) following laparoscopic
surgery under general anesthesia ranges from 50-
70% depending on surgical and patient related
factors. Several PONVrisk scores are available,
among which Apfel’s score considers four risk
factors which includes 1) female gender, 2) previous
history of motion sickness or post-operative nausea
and vomiting, 3) nonsmoking status 4) use of
postoperative opioids.
Materials and Methods: A prospective study
was conducted from December 2011 to January
2013 on all patients undergoing laparoscopic
cholecystectomy, without the use of prophylactic
anti-emetics to predict postoperative nausea
and vomiting using Apfel’s score. Perioperative
anesthetic care was standardized in all patients.
Rescue opioid analgesic (Pethidine) was given if
not relived by standardized analgesics. Patients
were thenobserved for PONV for 24 hours. Those
who suffered from PONV received appropriate
anti-emetics if required.
Results: Total 122 patients underwent laparoscopic
cholecystectomy during the study period. Female to
male ratio was 3.2:1. PONV was present in 49.2%
of patients. In our study the predictive percentage
of patients suffering from PONV for scores 0, 1, 2,
3 and 4 were 0%, 11.1%, 46.6%, 66.6% and 70%
respectively. P value was significant with all factors
except previous history of PONV/motion sickness.
Conclusion: In our study, Apfel’s score was found
to be a good predictor for PONV in laparoscopic
cholecystectomy. Out of four risk factors except
previous history of PONV/motion sickness,
remaining were individually statistically significant
in predicting PONV. Those patients with high
Apfel’s score require prophylactic anti-emetics.
References
1. Bellows CF, Berger DH, Crass RA.
Management of gallstones. Am Fam Physician
2005; 72:637-42.
2. Gallstone and laparoscopic cholecystectomy.
NIHC consensus Development Panel on Gallstones
and Laparoscopic Cholecystectomy. Surg Endosc
1993 May-Jun;7(3):271-9.
3. Sandor J, Sandor A, Zaborszky A, Meqyaszai
S, Benedek G, Szeberin Z. Why laparoscopic
cholecystectomy today?. Surg Today 1996;26:556-
60.
4. Liberman MA, Howe S, Lane M. Ondansetron
versus placebo for prophylaxis of PONV in
patients undergoing ambulatory laparoscopic
cholecystectomy. Am J Surg 2000 Jan;179(1):60–2.
5. Watcha MF, White PF. Postoperative nausea and
vomiting: its etiology, treatment, and prevention.
Anesthesiology 1992 Jul ;77(1):162-84.
6. Iitomi T, Toriumi S, Kondo A, Akazawa T,
Nakahara T. Incidence of nausea and vomiting
after cholecystectomy performed via laparotomy or
laparoscopy. Masui 1995 Dec;44(12):1627-31.
7. Sinclair DR, Chung F, Mezei G. Can postoperative
nausea and vomiting be predicted?. Anesthesiology
1999 Jul;91(1):109-18.
8. Apfel CC, Laara E, Koivuranta M, Greim CA,
Roewer N. A simplified risks score for predicting
postoperative nausea and vomiting: conclusions
from cross-validations between two centers.
Anesthesiology 1999 Sep;91(3):693-700.
9. Wilson EB, Bass CS, Abrameit W, Roberson R,
Smith RW. Metoclopromide versus Ondansetron in
prophylaxis in nausea and vomiting for laparoscopic
cholecystectomy. Am J Surg. 2001 Feb;181(2):138-
41.
10. Koivuranta M, Laara E, Snare L, Alahuhta S.
A survey of postoperative nausea and vomiting.
Anesthesia 1997 May;52:443-9.
11. Pearman MH. Single dose intravenous
Ondansetron in the prevention of postoperative
nausea and vomiting. Anaesthesia 1994 Jan;49
Suppl: 11-5.
12. Moussa AA, Oregan P. Prevention of
postoperative nausea and vomiting in patients
undergoing laparoscopic bariatric surgery. M.E.J
Anesth 2007;19(2):357-67.
13. Weilbach C, Meyer NR, Raymondos K, Weissig
A, Scheinichen D, Piepenbrock S. Postoperative
Nausea and Vomiting (PONV) : Usefulness of the
Apfel-Score for identification of high risk patients
for PONV. Acta Anaesth. Belg 2006;57:361-3