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Postoperative nausea and vomiting

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October 12. 2013
Glenn Arnold
November 13. 2013
Geoffrey Lockwood

We record these outcomes in the Recovery ward but they'd be much more useful if we can get them from the ward too. I found I had little PONV in Recovery but 34% on the ward after my major gynae. Perhaps I'll ask our ward if they can see a way of collecting these numbers.

November 17. 2013
Glenn Arnold

Very interesting.

We looked at pain in all gynae patients earlier in the year and identified quite high variability in pain in recovery for different groups of patients between anaesthetists, we circulated the "recipe" of the best performing anaesthetists, this resulted in a 47% reduction in moderate to severe pain in recovery, largely due to a 306% increase in opioid use, interestingly PONV in recovery also went down and comfortable patients left recovery faster.

It also appears laparoscopic hysterectomies are in more pain than open hysterectomies, (they receive less opioid).

Also, myomectomies are sore despite quite large amounts of opioid and no-one does them well. We're about to look at these patients the following day as quite a few people have started using central neuraxial blocks with diamorphine and we will have a look at PONV in recovery and the following day to see if we see a similar problem as you.

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