Post-operative Nausea and Vomiting Following Regional Anaesthesia at a Low-income Country Tertiary Hospital

Abstract

INTRODUCTION: Post-Operative Nausea and Vomiting (PONV) is one of the complications associated with surgery and anesthesia especially with current advancements in both specialties increasing operations done under regional anesthesia rather than general anesthesia. PONV incidence and associated factors in our setting after regional anesthesia remain unknown yet suboptimal management causes distress postoperatively. OBJECTIVE: We studied the incidence and the factors associated with Post-Operative Nausea and Vomiting among surgical patients undergoing regional anesthesia in Mulago National Referral and Teaching Hospital. METHODOLOGY: This was a prospective cohort study, registered at ClinicalTrials.gov as study number NCT03835234. Patients aged 18 years and above that were planned for surgery under regional anesthesia at Mulago National Referral and Teaching Hospital were consented and enrolled into the study over a six month period. Data was collected using pre-tested, semi structured questionnaires. Patients were post operatively observed for 24 hours. We determined the incidence of and factors associated with PONV which were submitted to multiple logistic regression analysis to determine a PONV causal relationship. RESULTS: Out of 364 participants, 140(38%) experienced PONV. Factors associated with PONV in our setting were history of nausea or vomiting(AOR=3.49, 95% CI 1.53 - 7.96 ), motion sickness(AOR= 2.36, 95% CI 1.20 - 4.65), history of PONV(AOR= 2.61, 95% CI 1.25 - 5.46 ), age(AOR= 1.03,95% CI 1.01 - 1.06),ASA 2 classification(AOR=0.36,p=0.016), less than two hours of preoperative fasting(AOR=4.09, 95% CI 0.16 - 0.83) and low blood pressure(AOR=4.99, 95% CI 1.72 - 14.48 ). Ninety two participants (25.3%) received anti-emetics perioperatively. CONCLUSION: The incidence of PONV following surgery under regional anesthesia at MNRTH is higher than elsewhere reported. Some factors associated with PONV were similar to those in other studies, while others were unique to this study. 25% of the patients received PONV prophylaxis.