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Reduction of postoperative nausea and vomiting risk in the second stage during bilateral total knee arthroplasty with a 1-week interval

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Total knee arthroplasty (TKA) is often performed sequentially on both sides during a single hospital stay. Patients who experience postoperative nausea and vomiting (PONV) after the first operation are concerned about PONV recurrence after the second operation. However, there are few studies regarding the incidence of PONV in staged bilateral TKA with a ≥ 1-week interval. This study aimed to identify the differences in (1) PONV incidence, (2) use of rescue antiemetics, and (3) the amount of opioid consumption between the first and second operations for staged bilateral TKA with a 1-week interval. Based on our anecdotal experience, the hypothesis of this study was that during staged bilateral TKA at a 1-week interval, the PONV incidence and rescue antiemetic requirement after the second operation will be lower than those after the first operation, regardless of opioid consumption.

Methods

Fifty-eight consecutive patients who underwent staged bilateral TKA with a 1-week interval were retrospectively reviewed. All second-stage operations were performed with the same anaesthesia protocol and perioperative patient management protocol as the first-stage operation. PONV incidence was the primary outcome. The requirement for rescue antiemetic drugs and the amount of opioid consumption were secondary outcome variables. The outcome variables were recorded during three postoperative days (Days 0–2) for each stage and were compared between the first and second operations.

Results

The incidence rates of nausea and vomiting on Day 0 (p = 0.001 and p = 0.004, respectively) and nausea on Day 1 (p = 0.008) were significantly lower after the second operation. Rescue antiemetic use on Day 0 was significantly lower after the second operation (p = 0.001). The total opioid consumption 72 h after surgery was significantly higher after the second operation (61.76 vs. 34.28 mg, p < 0.001).

Conclusion

During staged bilateral TKA with a 1-week interval, PONV incidence was lower after the second operation, even with increased opioid consumption.

Level of evidence

III.

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Abbreviations

HPA:

Hypothalamic–pituitary–adrenal

MED:

Morphine equivalent dose

PCA:

Patient-controlled analgesia

PONV:

Postoperative nausea and vomiting

TKA:

Total knee arthroplasty

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Funding

There are no sources of funding used in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea

    Na-Kyoung Lee, Sanghyo Kim, Jong Seop Kim, Chang-Jin Yon, Byeong-Eun Im & Chong Bum Chang

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Chong Bum Chang

Authors
  1. Na-Kyoung Lee
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  2. Sanghyo Kim
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  3. Jong Seop Kim
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  4. Chang-Jin Yon
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  5. Byeong-Eun Im
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  6. Chong Bum Chang
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Contributions

The authors have made the following contributions: (1) the conception and design (NKL, SK, CBC), analysis and interpretation of the data (NKL, JSK, CJY, BEI, CBC), (2) drafting of the article (NKL), critical revision of the article for important intellectual content (SK, JSK, CJY, BEI, CBC), (3) final approval of the article (NKL, SK, JSK, CJY, BEI, CBC).

Corresponding author

Correspondence to Chong Bum Chang.

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Conflict of interest

The authors have no competing financial interests.

Ethical approval

This study was approved by the local ethical committee in Seoul national university Bundang hospital, Gyenggi-do, Korea (B-2109-707-101).

Informed consent

The requirement for informed consent was waived due to the retrospective nature of the study.

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Lee, NK., Kim, S., Kim, J.S. et al. Reduction of postoperative nausea and vomiting risk in the second stage during bilateral total knee arthroplasty with a 1-week interval. Knee Surg Sports Traumatol Arthrosc 30, 3114–3119 (2022). https://doi.org/10.1007/s00167-022-06902-x

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  • DOI: https://doi.org/10.1007/s00167-022-06902-x

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