Clinical Trial: Prevention of Postoperative Nausea and Vomiting (PONV) in Surgical Patients

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Prevention of Postoperative Nausea and Vomiting in Surgical Patients

Brief Summary: This study will compare two different drug regimens (oral dronabinol versus intravenous ondanseteron) for the prevention of post-operative nausea and vomiting (PONV).

Detailed Summary:

Anesthesia has become remarkably safe during the past two decades, yet postoperative nausea and vomiting (PONV) continues to be a vexing problem with an unacceptably high incidence. Multiple factors including age, gender, type of surgery and anesthetic agents, perioperative opioid use and duration of anesthesia have been implicated in the cause of PONV. Several new drugs have been introduced during the last two decades to minimize PONV; however the incidence still remains significantly high, ranging from 30% during the first 24 postoperatively to 35% post discharge. Unrelenting PONV results in delayed discharge which is particularly significant after outpatient surgery. The proposed study will examine the anti-emetic properties of orally administered dronabinol given immediately prior to surgery with standard of care intravenous ondansetron given at the end of a surgical procedure in an effort to assess the need for cost effective prophylaxis of PONV.

The chemoreceptor trigger zone (CTZ) functions as emetic chemoreceptor for the vomiting centers. Many antiemetic drugs acting at the level of the CTZ are responsible for vomiting in patients receiving chemotherapy and postoperative patients. Our regimen of oral dronabinol has been proven to reduce the incidence of PONV in patients receiving chemotherapy. We intend to prove that a regimen that has been utilized in patients receiving chemotherapeutic drugs will work in patients with a high risk for developing PONV following surgery. We hypothesize that a regimen of preoperative low dose of dronabinol is superior in efficacy to a standard antiemetic in preventing the incidence of PONV, and thus will not only improve patient satisfaction but will also reduce length of stay in patients undergoing outpatient surgery.

Specific Objectives

1. Incidence of Postoperative Nausea and Vomiting [ Time Frame: Post-operative Care Unit (PACU) length of stay on day of surgery (time from end of surgery to transfer to discharge unit or other hospital unit) ]
   The incidence of postoperative nausea (PON) and postoperative vomiting (POV) was assessed during Post-operative Care Unit (PACU) stay.
2. Maximum Reported Post-Operative Nausea Scores on Visual Analog Scale (VAS) Scale [ Time Frame: Post-operative Care Unit (PACU) stay from end of surgery to transfer to ambulatory unit ]

   VAS Scale: 0=no nausea, 1-3=mild nausea, 4-6= moderate nausea, 7-9= severe nausea, 10=extreme nausea usually accompanied with vomiting.

   VAS nausea score were obtained every 30 min from entry into post-operative care unit (PACU) for first 2 hrs. and then hourly until time of transfer out of PACU.

3. Post-operative Nausea and Vomiting (PONV) Incidence 24-48 Hours Post Surgery [ Time Frame: 24-48 hrs post surgery ]
   Participants were queried for presence of postoperative nausea (PON) or postoperative vomiting (POV) during the 24-48 hr window post surgery.




Original Primary Outcome: Postoperative nausea [ Time Frame: 4 weeks ]



Current Secondary Outcome:

• Post-Operative Care Unit Length of Stay (Min) [ Time Frame: Day of surgery (time from end of surgery to transfer to ambulatory pre-discharge unit or other unit) ]
  Length of time in PACU (minutes) measured from end of surgery to time of transfer to ambulatory care prior to home discharge or time to hospital admission if applicable.
• Post-Surgery Hospital Admissions (All Cause) After Out-patient Abdominal Procedure [ Time Frame: Post-operative Day of Surgery (DOS) ]
  Number of all-cause hospital admissions on day of elective out-patient surgery .
• Post-operative Antiemetic Use [ Time Frame: End of surgery to 48 hr post surgery ]
  Percentage of participants requiring post-operative anti-emetic medications.. Anti-emetic medication need was assessed during a) post-operative care unit (PACU) stay and b)during the first 48 hrs. following discharge from PACU to home or if applicable to in-patient unit.
• Patient Satisfaction: Willingness to Take Pre-operative Medication for Post-operative Nausea and/or Vomiting [ Time Frame: Post operative follow up interviews 24 hrs to 6 wks ]
  Percent of participants who responded that they would be willing to take preemptive medication for nausea and vomiting for subsequent surgeries when queried during post-operative follow-up interviews at 24-48 hrs or 2-6 weeks.
• Patient Satisfaction 2: Willingness to Pay Extra Money for Post-Operative Nausea and Vomiting (PONV) Preventive Medication [ Time Frame: Post-operative follow-up interviews 24 hr to 6 weeks post surgery ]
  Percent of participants willing to pay extra money for preemptive medication for PONV for subsequent surgical procedures when queried at post-operative 24-48 hr. and at 2-6 wk. follow-up interviews.




Original Secondary Outcome:

Information By: VA Office of Research and Development


Dates:
Date Received: September 19, 2008
Date Started: December 2009
Date Completion:
Last Updated: April 7, 2016
Last Verified: April 2016