A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine. (November 2020)

• Record Type: Journal Article
• Authors: Tan, H.S.; Cooter, M.; George, R.B.; Habib, A.S.
• Is Part Of: International journal of obstetric anesthesia. Volume 44(2020)
• Page Start: 126
• Page End: 130
• Publication Date: 2020-11
• Subjects: Apfel score -- Cesarean delivery -- Intrathecal opioids -- Neuraxial anesthesia -- Postoperative nausea/vomiting; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2020.08.008
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: There is no risk score for postoperative nausea and/or vomiting (PONV) in parturients. We assessed potential parturient and peri-operative risk factors for PONV. Non-smoking, history of PONV after cesarean and/or morning sickness increase risk. All factors were included in an obstetric-specific risk score (Duke score) Both Duke and Apfel risk scores performed poorly in prediction of PONV. Abstract: Background: Postoperative nausea and/or vomiting affects up to 80% of parturients undergoing cesarean delivery, but there is a lack of obstetric-specific risk-prediction models. We performed this study to identify postoperative nausea/vomiting risk factors in parturients undergoing cesarean delivery, formulate an obstetric-specific prediction model (Duke score), and compare its performance against the Apfel score. Methods: A post-hoc analysis of data from two randomized controlled trials studying nausea/vomiting in women undergoing cesarean delivery with intrathecal morphine. Potential risk factors for postoperative nausea/vomiting within 24 h of surgery with univariate associations with P ≤0.20 were considered for inclusion in the multivariable analysis. After identifying the final multivariable model, we derived our Duke score by assigning points to the selected factors. We then tested the association of the Duke and Apfel scores with postoperative nausea and vomiting, and compared the area-under-the-receiver operating characteristic curve. Results: Analysis included 260 parturients, of whom 146 (56.2%) experienced postoperative nausea/vomiting. Non-smoking during pregnancy (OR 2.29 [95% CI 1.12 to 4.67], P =0.023), and history of postoperative nausea/vomiting after cesarean delivery and/or morning sickness (2.09 [1.12 to 3.91], P =0.021) were independent predictors of postoperative nausea/vomiting and included in the Duke score. Both Duke and Apfel scores trended linearly with postoperative nausea/vomiting risk (Duke P =0.001; Apfel P =0.049) and had comparable areas-under-the-receiver operating characteristic curve (Duke 0.63 [0.57 to 0.70]; Apfel 0.59 [0.52 to 0.65], P =0.155). Conclusions: Both Duke and Apfel scores exhibited similar but poor predictive performance. Until better tools are developed, routine prophylactic anti-emetics appears to be a reasonable approach in this patient population.