Nerve Blocks Tied to Less Nausea and Vomiting after Orthopedic Surgery

San Francisco, CA—April 7, 2017

When patients are given peripheral nerve blocks as their primary anesthetic, they are less likely to experience nausea and vomiting after orthopedic surgery.  This trend existed regardless of if the peripheral nerve block was paired with general anesthesia, intravenous sedation, or spinal anesthesia, new data suggests.

The new research, conducted by researchers at Hospital for Special Surgery (HSS), was presented today at the annual meeting of the American Society of Regional Anesthesiologists (ASRA).  The team of investigators reported the rates and intensity of nausea among three groups of orthopedic patients -- patients who received an interscalene nerve block with general anesthesia during shoulder replacement surgery (n=15); patients who received an interscalene nerve block with intravenous sedation during shoulder replacement surgery (n=15); and patients who received sciatic and adductor canal nerve blocks combined with spinal anesthesia during foot and ankle surgery (n=15).

Peripheral nerve blocks, a type of regional anesthesia, can be used for many types of surgery to numb part of the body for an operation, but in many cases, nerve blocks are insufficient in ensuring patient satisfaction and in meeting surgeons' needs and must be paired with a secondary anesthetic. While general anesthesia can be used on its own, its use can be associated with severe nausea and vomiting. The researchers sought to investigate if peripheral nerve blocks, paired with general anesthesia, spinal anesthesia, or intravenous sedation, would have the same disadvantages of general anesthesia on its own.

The incidence of nausea was low among all patient groups, and there were no notable differences in the severity of nausea. Recovery was similar over emotional, physiological, and cognitive measurements.

"Peripheral nerve blocks, given with an opioid sparing anesthetic and prophylactic antiemetics, are associated with a low incidence of nausea of mild to moderate intensity," commented Jacques YaDeau, MD, PhD, director of research within the Department of Anesthesiology at HSS.

"Randomized controlled trials are needed to address whether the choice of sedation, spinal, or general anesthesia influences nausea or postoperative quality of recovery in the presence of adequate peripheral nerve blockade," noted Dr. YaDeau.

References

Luu TH, Roberts MM, Gadulov Y, Fields KG, Kahn RL, Gulotta  LV, Dines DM, Levine DS, LaSala VR, Gordon MA, Paroli L,  YaDeau JT. “Recovery Profile among Orthopedic Patients Receiving Peripheral Nerve Blocks. A Pilot Study.” Abstract presented at: American Society of Regional Anesthesiologists 2017 Annual Meeting; April 6-8; San Francisco, CA.