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BJA Advance Access published online on September 16, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei227
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oxfordjournals.org

Review Article

Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritis, and urinary retention. Evidence from published data

S. J. Dolin 1 and J. N. Cashman 2*

1 Pain Clinic, St Richard's Hospital, Chichester PO19 6SE, UK
2 Department of Anaesthesia, St George's Hospital, London SW17 0QT, UK

* To whom correspondence should be addressed.
J. N. Cashman, E-mail: jeremy.cashman{at}stgeorges.nhs.uk


  Abstract

This review examines the evidence from published data concerning the tolerability (indicated by the incidence of nausea, vomiting, sedation, pruritis, and urinary retention), of three analgesic techniques after major surgery; intramuscular analgesia (i.m.), patient-controlled analgesia (PCA), and epidural analgesia. A MEDLINE search of publications concerned with the management of postoperative pain and these indicators identified over 800 original papers and reviews. Of these, data were extracted from 183 studies relating to postoperative nausea and vomiting, 89 relating to sedation, 166 relating to pruritis, and 94 relating to urinary retention, giving pooled data which represent a total of more than 100 000 patients. The overall mean (95% CI) incidence of nausea was 25.2 (19.3-32.1)% and of emesis was 20.2 (17.5-23.2)% for all three analgesic techniques. PCA was associated with the highest incidence of nausea but the emesis was unaffected by analgesic technique. There was considerable variability in the criteria used for defining sedation. The overall mean for mild sedation was 23.9 (23-24.8)% and for excessive sedation was 2.6 (2.3-2.8)% for all three analgesic techniques (significantly lower with epidural analgesia). The overall mean incidence of pruritus was 14.7 (11.9-18.1)% for all three analgesic techniques (lowest with i.m. analgesia). Urinary retention occurred in 23.0 (17.3-29.9)% of patients (highest with epidural analgesia). The incidence of nausea and excessive sedation decreased over the period 1980-99, but the incidence of vomiting, pruritis, and urinary retention did not. From these published data it is possible to set standards of care after major surgery for nausea 25%, vomiting 20%, minor sedation 24%, excessive sedation 2.6%, pruritis 14.7%, and urinary retention requiring catheterization 23%. Acute Pain Services should aim for incidences less than this standard of care.

Keywords: analgesia, intramuscular; analgesia, epidural; analgesia, patient-controlled; pain, postoperative.
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E-letters:

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Standards of care for acute pain management
James B Sartain
British Journal of Anaesthesia, 9 Nov 2005 [Full text]
Tolerability of acute postoperative pain management.
Wolfgang H. Maleck
British Journal of Anaesthesia, 19 Dec 2006 [Full text]
Tolerability of acute postoperative pain management
Jeremy N Cashman, et al.
British Journal of Anaesthesia, 22 Jan 2007 [Full text]

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