INCIDENCE OF AND FACTORS ASSOCIATED WITH POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING SURGERY UNDER REGIONAL ANAESTHESIA IN MULAGO HOSPITAL

Abstract

INTRODUCTION: Post-operative nausea and vomiting (PONV) is one of the complications associated with surgery and anaesthesia. Due to advanced techniques in the field of anaesthesia and surgery, patients are commonly operated on under regional anaesthesia (RA) rather than general anaesthesia (GA). Post-operative nausea and vomiting (PONV) still occurs with regional anaesthesia, but the incidence and associated factors in our setting remain unknown. An optimal management of PONV is important because they can lead to increased morbidity. OBJECTIVE: The main aim of the study was to determine the incidence of post-operative nausea and vomiting among surgical patients undergoing regional anaesthesia in Mulago hospital and the factors associated with it. METHODOLOGY: This was a prospective cohort study, registered at clinicalTrials.gov as study number NCT03835234. Patients aged 18 years and above in whom surgery under regional anaesthesia was planned at Mulago hospital were consented and enrolled into the study over a 6month period. Data was collected using pre-tested, semi structured questionnaires. Patients were observed for up to 24 hours post operatively to determine the incidence of and factors associated with PONV in regional anaesthesia in Mulago hospital. These factors were submitted to multiple logistic regression analysis to determine their relationship to PONV. RESULTS: Out of 364 participants, 140(38%) experienced PONV. Factors associated with PONV in our setting were history of nausea or vomiting(AOR=3.49, 95% CI 1.53 - 7.96 ), motion sickness(AOR= 2.36, 95% CI 1.20 - 4.65), history of PONV(AOR= 2.61, 95% CI 1.25 - 5.46 ), age(AOR= 1.03,95% CI 1.01 - 1.06),ASA 2 classification(AOR=0.36,p=0.016), less than two hours of preoperative fasting(AOR=4.09, 95% CI 0.16 - 0.83) and low blood pressure(AOR=4.99, 95% CI 1.72 - 14.48 ). Ninety two participants (25.3%) received anti-emetics peri-operatively. CONCLUSION: The incidence of PONV following surgery under regional anaesthesia at Mulago hospital is higher than that reported elsewhere. Some factors associated with PONV were similar to those in other studies, while others were unique to this study. Very few patients received PONV prophylaxis.