Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients Undergoing Same-day Surgery

Improving Perioperative Care in Gastric Surgery: Insights from the EUropean PErioperative MEdical Networking (EUPEMEN) Project

Background/Objectives: Gastric cancer remains a leading cause of cancer-related deaths worldwide and surgical resection represents the mainstay of treatment procedures. However, despite the advancements noted in the field of surgical oncology, perioperative complications and variability in the perioperative care provided persist. To address the challenges caused by non-standardized perioperative care for gastric surgery across European healthcare systems, the EUropean PErioperative MEdical Networking (EUPEMEN) protocol has been developed. The present study concisely provides the EUPEMEN protocol's development, implementation, and impact on perioperative management in gastric resections. Methods: The EUPEMEN protocol was developed through a multidisciplinary collaboration involving five academic healthcare professionals from four European countries. The main activities of the collaborative group included a literature review, consensus development, the creation of multimodal rehabilitation manuals, and the development of an online learning platform. The EUPEMEN project aims for the uniform adoption of evidence-based practices across preoperative, intraoperative, and postoperative phases, leading in nutritional, psychological, and physiological optimization. Results: The implementation of the EUPEMEN protocol aims to optimize perioperative outcomes, including reduced postoperative complications, a shorter length of hospitalization, and improved recovery trajectories. The above have been achieved through structured guidelines that ensure consistent care delivery across diverse healthcare settings and tools such as rehabilitation manuals and a free-access online educational platform. Conclusions: The EUPEMEN protocol represents a new standard for perioperative care in the field of gastric surgery that is based on multidisciplinary collaboration and evidence-based practices. While challenges such as resource constraints and variability in adherence remain, the protocol demonstrates significant potential to improve patient outcomes and streamline perioperative management. Future research should focus on long-term effects and adaptation challenges in the setting of non-European healthcare systems.

Study of penehyclidine for the prevention of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy under general anesthesia: a randomized, prospective, double-blind trial

PURPOSE

To investigate the efficacy of penehyclidine (PHC) for preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) under general anesthesia.

MATERIALS AND METHODS

In this prospective study, 219 patients who were scheduled to undergo LSG were randomly assigned to three cohorts: the control cohort (received normal saline), the infusion cohort (administered 0.25 mg of PHC intravenously followed by an additional 0.25 mg through an intravenous analgesia pump for 48 h after LSG), and the bolus cohort (received a single intravenous dose of 0.5 mg of PHC). The study outcomes included the incidence of PONV within the first 48 h postoperatively, the severity and intensity of PONV, side effects and postoperative recovery outcomes. Univariate and multivariate logistic analyses were performed to identify independent risk factors associated with PONV.

RESULTS

Compared with the control cohort, both the infusion and bolus cohorts presented considerably lower incidences of PONV (61.64% vs. 12.33% vs. 38.36%, P < 0.05), as well as significantly decreased PONV severities (P < 0.05) and intensities (P < 0.05). There were no significant differences in side effects and postoperative recovery outcomes among the three cohorts, with the exception of dry mouthand the administration of rescue antiemetic therapy (P < 0.05). Additionally, the Apfel risk score and PHC intervention were identified as independent risk factors associated with PONV incidence following LSG (P < 0.05).

RESULTS

PHC effectively prevented PONV occurrence and reduced its severity in LSG patients without decreasing postoperative recovery outcomes, particularly in the infusion cohort.

The outpatient experience in unicompartmental knee arthroplasty: How to perform safely in the ambulatory surgery center

The number of outpatient unicompartmental knee arthroplasty (UKA) procedures has increased substantially over the last decade. The ambulatory surgery center (ASC) and hospital outpatient department provide a safe, cost-effective alternative with significant cost savings to the healthcare system. Advancements in technology and perioperative management strategies have expanded the number of eligible patients to optimize outcomes with a focus on safety. Therefore, this review will describe the safety, efficacy, economics, and perioperative protocols for performing UKA in an outpatient setting. Patient selection, risk factors, patient education and expectations, anesthesia, pain management strategies, and outcomes will be discussed.

The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Acute Appendicitis: Recommendations for Perioperative Care

Background/Objectives: Acute appendicitis (AA) is one of the most common causes of emergency department visits due to acute abdominal pain, with a lifetime risk of 7-8%. Managing AA presents significant challenges, particularly among vulnerable patient groups, due to its association with substantial morbidity and mortality. Methods: The EUPEMEN (European PErioperative MEdical Networking) project aims to optimize perioperative care for AA by developing multidisciplinary guidelines that integrate theoretical knowledge and clinical expertise from five European countries. This study presents the key elements of the EUPEMEN protocol, which focuses on reducing surgical stress, optimizing perioperative care, and enhancing postoperative recovery. Results: Through this standardized approach, the protocol aims to lower postoperative morbidity and mortality, shorten hospital stays, and improve overall patient outcomes. The recommendations are tailored to address the variability in clinical practice across Europe and are designed to be widely implementable in diverse healthcare settings. Conclusions: The conclusions drawn from this study highlight the potential for the EUPEMEN protocol to significantly improve perioperative care standards for AA, demonstrating its value as a practical, adaptable tool for clinicians.

Opioids and personalized analgesia in the perioperative setting: A protocol for five systematic reviews

BACKGROUND

Treatment with opioids is a mainstay in perioperative pain management. While the leading treatment paradigm has been procedure-specific pain management, efforts regarding personalized pain treatment are increasing. The OPI•AID project aims to develop personalized algorithms for perioperative pain management, taking demographic, surgical, and anaesthesiologic factors into account. We will undertake five parallel reviews to illuminate current evidence on different aspects of individual responses to perioperative opioid treatment.

METHODS

Inclusion of adult populations in English-written studies. Review-specific searches are developed for the following databases: CENTRAL, MEDLINE, Embase, clinicaltrials.gov, and clinicaltrial.eu. Two authors will independently screen citations, extract data, and assess the risks of bias in each review (QUIPS, PROBAST and RoB2, as relevant).

CONCLUSION

These reviews will evaluate various aspects of perioperative opioid treatment, including individualized treatment strategies, selection of specific opioids, and individual patient responses. These will guide future development of a personalized perioperative opioid treatment algorithm (OPI•AID) that will be validated and tested clinically against standard of care.

Comparison of predictive models in postoperative nausea and vomiting in patients undergoing breast cancer surgery

BACKGROUND

Post-operative nausea and vomiting remain an unresolved concern in Türkiye and some parts of the world, impacting the quality of the patient's recovery process and diminishing overall satisfaction.

OBJECTIVE

This study was conducted as a descriptive investigation to compare the incidence of nausea and vomiting following breast cancer surgery with the nausea and vomiting risk scores proposed by Apfel and Koivuranta.

METHODS

This study was conducted with 100 patients admitted to the General Surgery service of a university hospital between 31 August 2019 and 31 May 2021 for breast cancer surgery. The patient information form developed by the researchers, Apfel Nausea and Vomiting Risk Score, and Koivuranta Nausea and Vomiting Risk Score were used as data collection tools.

RESULTS

It was identified that 61% of the patients experienced nausea and vomiting within the initial 24 h following surgery. A significant correlation was found between age, post-operative opioid use, motion sickness or history of PONV, and nausea and vomiting (p < 0,05). The sensitivity of the Apfel score obtained was 80%, the specificity was 46%, and the AUC value was 0.686. The sensitivity of the Koivuranta score was 80%, the specificity was 35%, and the AUC value was 0.675 (p < 0.05).

CONCLUSION

It has been observed that patients experience high rates of nausea and vomiting after breast cancer surgery and that the Apfel and Koivuranta Risk Scores are equally applicable in predicting post-operative nausea and vomiting.

Slower intravenous tramadol administration can prevent nausea and vomiting and predict postoperative nausea and vomiting: a randomized controlled trial

Objective

Nausea and vomiting are the most common complications in patients who use tramadol for analgesia. This study evaluated the risk of nausea and vomiting related to intravenous tramadol administration.

Methods

In this study, 315 patients who received pre-analgesia before elective surgery were selected, and participants were divided into groups based on the Apfel risk assessment of nausea and vomiting, as follows: high risk (Apfel=4), medium risk (Apfel=2-3), and low-risk (Apfel=1). Tramadol (1.5 mg/kg) was administered intravenously over a duration of 1 min, 2 min, or 3 min before anaesthesia induction to observe preoperative nausea and vomiting reactions within 10 min.

Results

In the low-risk group, the numeric rating scale for postoperative nausea scores and the incidence of nausea and vomiting were significantly lower in the 3-min group than those in the 1-min group, and the incidence of preoperative nausea and vomiting after intravenous administration of tramadol in the 1-min and 3-min groups were significantly related to the incidence of postoperative nausea and vomiting. The incidence of nausea and vomiting during pre-administration in the 1-min and 3-min groups was identified as an independent risk factor for postoperative nausea and vomiting.

Conclusions

In the clinical treatment of pain with tramadol, the slow intravenous application of tramadol within 3 min is worthy of being adopted and promoted by clinicians in their daily work.

Risk Factors of Acute Pain in Elderly Patients After Laparoscopic Radical Resection of Colorectal Cancer

OBJECTIVE

To investigate the risk factors of acute pain after laparoscopic radical resection of colorectal cancer (CRC) in elderly patients.

METHODS

Totally, 143 elderly patients (≥ 60 y old) who received laparoscopic radical resection of CRC in the People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to August 2022 were retrospectively analyzed. The patients were divided into 2 groups according to visual analog scale (VAS) scores 24 h after surgery: mild pain group (VAS score ≤ 3, n=108) and moderate to severe pain group (VAS score >3, n=35). The data of the patients, including sex, age, height, body mass, intraoperative blood loss, intraoperative urine volume, intraoperative opioid dosage, operation duration, preoperative Hospital Anxiety and Depression Scale (HADS) scores, preoperative Mini-Mental State Examination scores, VAS scores, postoperative nausea and vomiting scores were recorded. Multivariate logistic regression analysis was used to screen the risk factors of postoperative acute pain in elderly patients undergoing laparoscopic radical resection of CRC.

RESULTS

The preoperative HADS score of the moderate to severe pain group was significantly increased compared with that of the mild pain group (10.8±2.4 vs. 6.2±1.9), as well as the operation duration (226.4±18.3 vs. 186.1±12.7), the intraoperative dosage of remifentanil (3.7±0.2 vs. 3.2±0.4), the preoperative VAS score [4(2, 7) vs. 2 (0, 4)] and postoperative VAS score [5 (4, 6) vs. 3 (2, 3)] ( P <0.05). Multivariate logistic regression analysis showed that high preoperative HADS score, long operation duration, and high preoperative VAS score ( P <0.05) were independent risk factors for acute pain after laparoscopic radical resection of CRC in elderly patients.

CONCLUSION

Preoperative anxiety and depression, preoperative pain, and long operation duration are risk factors for acute pain in elderly patients after laparoscopic radical resection of CRC.