Anesthesia & Analgesia

Date Published: 
June 2008

Anesthesia & Analgesia

Re: "Avoiding Emetogenic Triggers in the First Place Is More Effective than
Using Antiemetics"

Congratulations to Gan et al. on their recent publication describing guidelines for the management and treatment of adults and children at risk for postoperative nausea and vomiting (PONV). Although regional anesthesia is mentioned as part of decreasing baseline PONV risk, the emphasis is heavily biased in favor of antiemetic therapy. The administration of adequate local analgesia may be the critical key to avoidance of emetogenic triggers and the subsequent PONV. Following this paradigm, a PONV rate of 0.5% in a high risk group of elective cosmetic surgery patients without the use of any antiemetics was published. Although this experience was lacking a control group, the results are consistent with other studies that included proper controls.

Barry L. Friedberg, M.D.
Corona del Mar, CA


1. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Trame`r MR, Vander Kolk C, Watcha M; Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615

2. Friedberg BL. Propofol-ketamine technique: dissociative anesthesia for office surgery: a five year review of 1264 cases. Aesthetic Plast Surg 1999;23:70

3. Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles of outpatients undergoing unilateral inguinal herniorraphy: a comparison of three anesthetic techniques. Anesth Analg 1999; 88:S30

4. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005;101:1634

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