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Canadian Journal of Anesthesia

, Volume 50, Issue 5, pp 514–518 | Cite as

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy

  • Shaheen Shaikh
  • Frances Chung
  • Charles Imarengiaye
  • Damian Yung
  • Mark Bernstein
Ncuroancsthcsia and Intensive Care

Abstract

Objective

Nowadays, microsurgical discectomy is being performed as an outpatient procedure. A retrospective chart review was done to document factors that delayed discharge or led to unanticipated admission.

Methods

After Institutional Review Board approval, the hospital medical records of 106 patients who underwent microsurgical discectomy on an ambulatory basis were reviewed. All patients were operated upon by a single surgeon at the Toronto Western Hospital. Perioperative data were collected on specifically designed data sheets. All anesthetic and surgical factors that affected discharge were noted.

Results

Of the 106 patients reviewed, only six required unanticipated admission. Two patients were admitted due to nausea and vomiting, one due to severe pain, one due to urinary retention and two were surgical causes (durai tear). Eight patients had delayed discharge. Anesthesia causes were severe nausea, severe pain, low oxygen saturation, sore throat and dry eyes. Two patients had surgical causes. The incidence of postoperative nausea was 61% and postoperative vomiting was 9.4%. Eighty patients (75.4%) complained of pain in the postanesthesia care unit. Of these, 33.9% had visual analogue pain scale scores more than 6.

Conclusion

Ambulatory lumbar microdiscectomy can be carried out as an ambulatory procedure with an acceptably low unanticipated admission rate (5.7%). The percentage of patients with severe nausea (16%) and pain (33.9%) is high. Adequate perioperative pain management and effective control of nausea and vomiting may further improve the patients’ experience after anesthesia for ambulatory microdiscectomy.

Keywords

Bupivacaine Ketorolac Desflurane Lumbar Disc Herniation Postoperative Nausea 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La douleur, les nausées, les vomissements et les complications oculaires retardent le départ après une microdiscoïdectomie ambulatoire

Résumé

Objectif

Aujourd’hui, la microdiscoïdectomie est réalisée en chirurgie ambulatoire. Une revue rétrospective des dossiers a été faite afin de consigner les facteurs qui retardent le départ ou mènent à une hospitalisation imprévue.

Méthode

Après avoir obtenu l’accord du Comité de révision institutionnel, nous avons passé en revu les dossiers médicaux de 106 patients qui ont subi une discoïdectomie microchirurgicale ambulatoire. Tous les patients ont été opérés par un seul chirurgien au Toronto Western Hospital. Les données périopératoires ont été recueillies sur des fiches techniques spécifiquement conçues pour l’étude. Tous les facteurs anesthésiques et chirurgicaux pouvant infuencer le départ ont été notés.

Résultats

Parmi les 106 patients dont on a revu le dossier, seulement six ont dû être hospitalisés. Deux ont été admis pour nausées et vomissements, un pour douleurs intenses, un pour rétention urinaire et deux pour des causes chirurgicales (lacération durale). Huit patients ont vu leur congé retardé. Les causes anesthésiques étaient des nausées sévères, de la douleur intense, une faible saturation du sang en oxygène, un mal de gorge et une sécheresse oculaire. Pour deux patients, les causes étaient chirurgicales. L’incidence de nausées postopératoires était de 61 % et de vomissements postopératoires de 9,4 %. Quatre-vingts patients (75,4 %) ont eu des douleurs en salle de réveil, dont 33,9% selon des scores de plus de 6 à l’échelle visuelle analogique.

Conclusion

La microdiscoïdectomie lombaire ambulatoire peut être réalisée comme telle et affiche un taux acceptable d’hospitalisation imprévue (5,7 %). Le pourcentage de patients victimes de nausées sévères (16 %) et de douleur (33,9 %) est toutefois élevé. Le traitement adéquat de la douleur périopératoire et le contrôle efficace des nausées et des vomissements atténueraient davantage les inconvénients de l’anesthésie.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Shaheen Shaikh
    • 1
  • Frances Chung
    • 1
  • Charles Imarengiaye
    • 1
  • Damian Yung
    • 1
  • Mark Bernstein
    • 2
  1. 1.Department of Anesthesia, Toronto Western HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Division of Neurosurgery, Toronto Western HospitalUniversity of TorontoTorontoCanada

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