Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Curr Opin Anaesthesiol. 2011 Dec;24(6):612-9. doi: 10.1097/ACO.0b013e32834b9468.
Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24 h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identification and management is necessary for improving outcomes and helping patients after discharge. This review will discuss possible PDNV specific risk factors, successful prevention and management of PDNV following ambulatory anesthesia and the principles and pharmacology of these interventions.
Current research has demonstrated beneficial PDNV management up to 72 h with the long-acting 5-hydroxytryptamine-3 receptor antagonist palonosetron. Neurokinin-1 antagonists have demonstrated superior antiemesis, but not antinausea compared with more traditional and less expensive options. Dexamethasone provides improvements in quality of recovery associated with improved PDNV outcomes.
Further PDNV specific research is needed, including PDNV predictive models in directing antiemetic interventions. Long-acting antiemetics and postdischarge oral antiemetics are effective in PDNV pharmacologic management. Neurokinin-1 receptor antagonists are effective in reducing the incidence of vomiting, but not nausea. The addition of nonpharmacologic interventions such as acustimulation may reduce PDNV. Multimodal analgesia including nonopioid analgesics and ambulatory continuous peripheral nerve blocks are encouraged to achieve adequate postoperative analgesia and reduce opioid induced PDNV.
尽管有大量研究关注术后和出院后恶心和呕吐（PONV/PDNV）长达 24 小时，但很少有研究关注“迟发性 PDNV”。随着门诊手术人群的增加，有必要确定特定的“迟发性 PDNV”风险，并在出院后对其进行管理，以改善患者的结局。本综述将讨论 PDNV 特定的可能风险因素，以及在门诊麻醉后成功预防和管理 PDNV，以及这些干预措施的原则和药理学。
目前的研究表明，使用长效 5-羟色胺 3 受体拮抗剂帕洛诺司琼，可在 72 小时内有效管理 PDNV。神经激肽-1 拮抗剂在抗呕吐方面优于传统且更便宜的选择，但在抗恶心方面并无优势。地塞米松改善了与 PDNV 结局相关的恢复质量。
需要进一步研究 PDNV 的特定问题，包括用于指导止吐干预的 PDNV 预测模型。长效止吐药和出院后口服止吐药在 PDNV 的药物治疗管理中有效。神经激肽-1 受体拮抗剂可有效降低呕吐发生率，但不能减轻恶心。添加非药物干预措施，如声刺激，可能会降低 PDNV 的发生率。鼓励使用多模式镇痛，包括非阿片类镇痛药和门诊连续外周神经阻滞，以达到足够的术后镇痛效果并减少阿片类药物引起的 PDNV。
