Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.
J Obstet Gynaecol Res. 2024 Oct;50(10):1857-1863. doi: 10.1111/jog.16087. Epub 2024 Sep 17.
This study aims to investigate the clinical practice of physicians working in obstetric setting toward postoperative nausea and vomiting (PONV) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia.
We conducted this online survey to all active members of the Japan Society of Obstetric Anesthesiology and Perinatology (JSOAP), where leads academic society in obstetric anesthesia in Japan. The questionnaire was developed using the Delphi method. The survey included questions about routine practices for PONV prevention, the use of neuraxial opioids, optimal practices, and perceived obstacles. The email sent three times every 2 weeks as a reminder.
A total of 1046 e-mails were sent, and 307 JSOAP members responded to the survey (29.3%). More than half of responders (62.7%) used neuraxial opioids with intrathecal morphine being the most frequent. They had a higher rate of multimodal PONV prophylaxis compared with who did not use neuraxial opioids for postoperative analgesia (19.9% vs 6.7%). Metoclopramide was the commonest medication for PONV prevention, and there was a significant difference in the use of 5-hydroxytryptamine receptor antagonists (19.9% vs. 8.6%, p = 0.012). We observed that 80% of physicians reported the routine administration of prophylaxis for PONV for CD. Among these, 20% indicated the use of two or more agents. Conversely, in the cohort not administering neuraxial opioids, only 6.7% reported the use of two or more agents.
The online survey showed that the physicians using neuraxial opioids for CD had a higher proportion of multimodal PONV management involving two or more agents.
本研究旨在调查在接受椎管内麻醉行剖宫产术的产妇中，产科医生在术后恶心呕吐（PONV）方面的临床实践。
我们向日本产科麻醉学会和围产学会（JSOAP）的所有活跃成员进行了这项在线调查，该学会是日本产科麻醉领域的主要学术团体。问卷采用德尔菲法制定。调查包括预防 PONV 的常规做法、使用椎管内阿片类药物、最佳做法和感知障碍等问题。电子邮件每两周发送三次作为提醒。
共发送了 1046 封电子邮件，有 307 名 JSOAP 成员回复了调查（29.3%）。超过一半的回复者（62.7%）使用了椎管内阿片类药物，其中最常用的是鞘内吗啡。与未使用椎管内阿片类药物进行术后镇痛的患者相比，他们采用了更高比例的多模式 PONV 预防方案（19.9% vs. 6.7%）。甲氧氯普胺是预防 PONV 的常用药物，5-羟色胺受体拮抗剂的使用存在显著差异（19.9% vs. 8.6%，p=0.012）。我们观察到 80%的医生报告常规为 CD 患者预防性使用 PONV 药物。其中，20%的医生表示使用了两种或更多种药物。相反，在未使用椎管内阿片类药物的患者中，只有 6.7%的医生报告使用了两种或更多种药物。
在线调查显示，在 CD 中使用椎管内阿片类药物的医生采用了更高比例的涉及两种或更多种药物的多模式 PONV 管理方案。
