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Postoperative nausea and vomiting (PONV) continue to be some of the most common and troublesome complications following anesthesia. Oliceridine, a G protein-biased µ-opioid receptor agonist, has the potential to provide effective pain relief while reducing the incidence of opioid-associated side effects. The aim of this study is to evaluate the effectiveness and safety of oliceridine for preventing PONV compared with morphine and a placebo. A comprehensive search was performed across PubMed/MEDLINE, Embase (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up to 30 September 2025, without any language limitations. Randomized controlled trials (RCTs) comparing oliceridine with morphine or placebo were included. Outcomes included incidence of nausea, vomiting, and other opioid-related adverse events (ORAEs). Pooled risk ratios (RRs) and their corresponding 95% confidence intervals (CIs) were estimated using random-effects models. This meta-analysis included five studies, with a total of 1,767 patients. The pooled analysis showed that oliceridine significantly reduced the incidence of postoperative nausea compared with morphine (risk ratio [RR] = 0.80; 95% confidence interval [CI] = 0.70-0.90). In dose-specific analyses, the RRs were 0.58 (95% CI = 0.50-0.67) for the 0.1 mg group, 0.82 (95% CI = 0.74-0.92) for the 0.35 mg group, and 1.00 (95% CI = 0.91-1.11) for the 0.5 mg group. Oliceridine also decreased the risk of postoperative vomiting (RR = 0.55; 95% CI = 0.45-0.67) relative to morphine. Subgroup analyses yielded RRs of 0.39 (95% CI = 0.31-0.50), 0.54 (95% CI = 0.38-0.78), and 0.80 (95% CI = 0.68-0.95) for the 0.1 mg, 0.35 mg, and 0.5 mg groups, respectively. Moreover, oliceridine appeared to lower the incidence of opioid-related adverse events, including dizziness (RR = 0.89; 95% CI = 0.76-1.04), dry mouth (RR = 0.50; 95% CI = 0.37-0.69), pruritus (RR = 0.50; 95% CI = 0.35-0.70), and somnolence (RR = 0.61; 95% CI = 0.45-0.82). Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, the certainty of evidence ranged from moderate to low. Oliceridine, particularly at 0.1-0.35 mg demand doses, reduces PONV and several opioid-related adverse events compared with morphine while maintaining effective analgesia. However, compared with placebo, typical opioid adverse effects remain. Further large-scale RCTs are warranted. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024604703, identifier PROSPERO (CRD42024604703).

Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Systematic review of randomized controlled trials (RCTs) with meta-analysis. Postoperative opioid consumption for various surgeries. Patients undergoing various surgeries. We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of - 12.83 (95% CI: - 17.29 to - 8.38; p < 0.001) mg; I = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01-6.61; p < 0.001; I = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I = 19%). ESPB is an effective technique on pain management with few complications.

Palonosetron is a second-generation 5-HT3 receptor antagonist with proposed higher efficacy and sustained action for prophylaxis of postoperative nausea and vomiting (PONV). Randomized controlled trials involving adult population undergoing elective surgery under general anesthesia comparing palonosetron to placebo, ramosetron, granisetron, and ondansetron were included. Data were extracted for vomiting incidence (VI), complete response (no nausea/vomiting; Complete Response [CR]), and rescue antiemetic need. This was categorized as early phase (24 hours postoperative for ramosetron and 6 hours for rest) and delayed phase (48 hours for ramosetron and 24 hours for rest). VI and CR were used as markers of drug efficacy. Any adverse effects were evaluated. Twenty-two trials (4 with 3 groups) were included (comparing palonosetron to placebo in 5, ramosetron in 5, granisetron in 4, and ondansetron in 12 subgroups). Palonosetron demonstrated statistical superiority over placebo for VI and CR, both early/delayed PONV prevention. For delayed phase, palonosetron surpassed ramosetron in all 3 variables; however, none of the variables attained statistical significance during early phase. In early phase, palonosetron had better VI and CR than did granisetron; however, variables other than CR (better for palonosetron) failed to achieve statistical significance for delayed phase. All 3 outcomes were significantly better for palonosetron compared with ondansetron in delayed phase, but statistical superiority could only be demonstrated for VI in early phase. Being inconsistently documented across trials, nausea scores could not be evaluated. Palonosetron is as safe as and more effective than placebo, ramosetron, granisetron, and ondansetron in preventing delayed PONV. For early PONV, it has higher efficacy over placebo, granisetron, and ondansetron.

Purpose Postoperative nausea and vomiting (PONV) is a frequent unappealing laparoscopic sleeve gastrectomy (LSG) sequel. The study’s purpose was to determine the prevalence, risk factors of PONV, and management of PONV after LSG. Patients and Methods This multicenter retrospective study included patients with morbid obesity who had LSG between January 2022 and April 2023. The age range for LSG was 16 to 65 years, and the eligibility requirements included morbid obesity according to international guidelines. Results PONV was experienced by 74.6% of patients who underwent LSG at 6 h postoperative. Multivariate analysis revealed that female gender, smokers, preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were found to be independent protective variables against the development of PONV. Combined intravenous ondansetron and metoclopramide improved 92.6% of patients who developed PONV. Dexamethasone and antihistamines drugs are given for 42 cases with persistent PONV after using intravenous ondansetron and metoclopramide. Pain management postoperatively by opioid-free analgesia managed PONV. Helicobacter pylori status has no role in the development of PONV after LSG. Conclusion Female gender, smoking, presence of preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were observed to be independent protective factors against the occurrence of PONV. Combined intravenous ondansetron and metoclopramide improved PONV. Dexamethasone and antihistamines drugs are given for persistent PONV. Graphical Abstract

Oliceridine, a novel biased mu-opioid receptor agonist, provides analgesia comparable to morphine but with a potentially improved side effect profile. However, the comparative incidence of opioid-related adverse events (ORADEs) in patient-controlled intravenous analgesia (PCIA) remains understudied. This study aims to elucidate the differences in ORADE rates between oliceridine and conventional opioids in PCIA. We conducted a population-based retrospective cohort study at Shanghai Chest Hospital, analyzing linked healthcare data. Propensity score matching (PSM) addressed selection bias. The study included patients who received PCIA with either oliceridine or conventional opioids (sufentanil, hydromorphone and oxycodone) after thoracoscopic lung resection from January 2024 to June 2024. ORADEs assessed included postoperative nausea and vomiting (PONV), urinary retention, and opioid-induced respiratory depression (OIRD). Demographics, clinical characteristics, and outcomes within the first 24 hours post-surgery were collected. From 8208 eligible patients, 3171 received oliceridine and 5037 received conventional opioids. After PSM, 2803 matched pairs were analyzed, with similar demographics and morphine equivalent doses between groups. The incidence of ORADEs was significantly lower in the oliceridine group compared to the conventional opioids group, with rates of 24.30% versus 27.83% (P < 0.01). Specifically, the oliceridine group had a reduced likelihood of PONV (15.45% vs 19.73%; Relative Risk [RR], 0.78; 95% confidence interval [CI] 0.70-0.88; P < 0.001). No significant differences were found in OIRD or urinary retention rates. Oliceridine use in PCIA was associated with a lower incidence of ORADEs, primarily driven by reduced PONV, compared to conventional opioids. These findings suggest oliceridine may be a safer alternative for postoperative pain management, warranting confirmation in larger prospective randomized trials. This study is among the first to provide a comprehensive comparative analysis of ORADEs between oliceridine and conventional opioids in a real-world PCIA setting, offering valuable insights into optimizing postoperative pain management strategies.

Background Postoperative nausea and vomiting (PONV) is common side effect after gastrointestinal surgery. It causses discomfort, increase risk of incision disruption, bleeding and airway blockage. This study aimed to investigate the incidence and severity of PONV and determine whether preoperative reflux or regurgitation symptoms influence PONV in patients undergoing bariatric surgery. Methods Patients with obesity underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in our center between January 2016 and December 2018 were divided into PONV and NoPONV group and analyzed retrospectively. PONV and postoperative pain visual analogue scale (VAS) were analyzed after surgery. A 1:1 propensity score matching (PSM) method was performed, and multivariable logistic regression analyses were used to identify predictors for PONV. Results There were 483 patients enrolled, with a mean age of 30.19 ± 9.96 years, and 134 pairs of matched patients were selected from PONV group and NoPONV group after PSM. PONV occurred in 288 (59.6%) patients after bariatric surgery (77.4% after LSG vs 21.5% after LRYGB, p  < 0.001). In PONV group, 210 (72.9%) were female, preoperative reflux or regurgitation symptoms were 128 (33.6%). Multivariable analysis found that preoperative reflux or regurgitation symptoms were independent risk factors for PONV after LSG, with an OR of 2.78 (95% CI: 1.12–6.93, p  = 0.028). Conclusions Incidence of PONV after bariatric surgery is high. For the first time, this study valued preoperative reflux or regurgitation symptoms as risk factors that may promote PONV after bariatric surgery. Patients with preoperative symptoms undergoing LSG have a higher risk of PONV, so these patients should be carefully evaluated for the feasibility of LSG before surgery.

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient's risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

Objective PONV reduces patient satisfaction and increases hospital costs as patients remain in the hospital for longer durations. In this study, we build a preliminary artificial intelligence algorithm model to predict early PONV in patients. Methods We use R for statistical analysis and Python for the machine learning prediction model. Results Average characteristic engineering results showed that haloperidol, sex, age, history of smoking, and history of PONV were the first 5 contributing factors in the occurrence of early PONV. Test group results for artificial intelligence prediction of early PONV: in terms of accuracy, the four best algorithms were CNNRNN (0.872), Decision Tree (0.868), SVC (0.866) and adab (0.865); in terms of precision, the three best algorithms were CNNRNN (1.000), adab (0.400) and adab (0.868); in terms of AUC, the top three algorithms were Logistic Regression (0.732), SVC (0.731) and adab (0.722). Finally, we built a website to predict early PONV online using the Streamlit app on the following website: ( https://zhouchengmao-streamlit-app-lsvc-ad-st-app-lsvc-adab-ponv-m9ynsb.streamlit.app/ ). Conclusion Artificial intelligence algorithms can predict early PONV, whereas logistic regression, SVC and adab were the top three artificial intelligence algorithms in overall performance. Haloperidol, sex, age, smoking history, and PONV history were the first 5 contributing factors associated with early PONV. Highlights 1 This is the first study to construct a predictive model for early PONV in patients using a variety of machine learning and deep learning techniques. 2 The study showed that artificial intelligence algorithms can predict early PONV, but logistic regression, SVC and adab were the three artificial intelligence algorithms with the best overall performance. 3 Finally, we built a website to predict early PONV online using the Streamlit app on the website: ( https://zhouchengmao-streamlit-app-lsvc-ad-st-app-lsvc-adab-ponv-m9ynsb.streamlit.app/ ).

Introduction Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (PONV). We aimed to compare the effects of aprepitant on the incidence of PONV after LSG. Methods In this double-blind, randomized controlled trial, the case group received the standard care regimen for PONV (dexamethasone 10 mg, ondansetron 4 mg, and metoclopramide 10 mg) plus prophylactic oral aprepitant 80 mg 1 h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24 h postoperatively. Results A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less PONV: early, 69 (34.3%) vs. 103 (51.7%), p  ≤ 0.001; 6 h, 67 (33.3%) vs. 131 (65.8%), p  ≤ 0.001; 12 h, 41 (20.4%) vs. 115 (57.8%), p  ≤ 0.001; and 24 h, 22 (10.9%) vs. 67 (33.7%), p  ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p  = 0.020; 6 h, 6 (3%) vs. 18 (9%), p  = 0.020; 12 h, 2 (1%) vs. 17 (8.5%), p  = 0.006; and 24 h, 1 (0.5%) vs. 6 (3%), p  = 0.040. Patients in the aprepitant group required less additional PONV medication: early, 61 (30.3%) vs. 86 (43.2), p  = 0.008; 6 h, 7 (3.5%) vs. 34 (17%), p  = 0.001; 12 h, 6 (3%) vs. 31 (15.6%), p  ≤ 0.001; and 24 h, 5 (2.5%) vs. 11 (5.5%), p  ≤ 0.001. Conclusions Prophylactic aprepitant improved PONV between 0 h (early) and 24 h postoperatively in patients undergoing LSG. Graphical Abstract

BackgroundLaparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery.MethodsData were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality.ResultsTen (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (p < 0.001). The ERAS group LOS decreased to 1.36 days vs 2.40 days in the pre-ERAS group (p < 0.001). 30-day readmission rates were 0% for ERAS patients vs 3.09% for pre-ERAS patients (p = 0.149). 30-day reoperation rates were 0% for ERAS patients vs 0.54% for pre-ERAS patients (p = 1). Thirty-day morbidity rates were 3.33% (3) for ERAS patients vs 3.27% for pre-ERAS patients (p = 1); there was no 30-day mortality in either group.ConclusionERAS for LSG results in a clinical and statistically significant reduction in postoperative opioid use and LOS, without increasing 30-day readmissions, reoperations, morbidity, or mortality.