Post- Surgery Recovery: Nerve Blocks w/ Sedation vs. Nerve Block w/ Either Sedation/Gen. Anesthesia
Condition: Nausea; Emesis
MeSH terms: Nausea
Study type: Observational

Summary: 
      Nausea after surgery may negatively influence patient satisfaction, may delay discharge, and
      cause unexpected hospital admissions. The trend toward ambulatory surgery has increased the
      focus on postoperative nausea, but published evidence is not based on standardized criteria
      for assessment. Therefore, the results for postoperative nausea are very diverse, especially
      reports on nausea incidence after regional anesthesia, i.e. spinal anesthesia. When
      peripheral nerve blocks have been applied for postoperative pain control, they significantly
      reduce postoperative pain, opioid consumption and side effects; patients receiving general
      anesthesia (GA) and nerve blocks are thought likely to have less nausea than patients
      receiving GA alone. This study is a pilot study looking at the incidence and intensity of
      nausea after orthopedic surgery under nerve blocks in foot and ankle (FA) patients and under
      nerve blocks with either sedation or GA in total shoulder arthroplasty (TSA) patients. The
      results of this study will help power a future randomized controlled trial, comparing the
      incidence and intensity of nausea in FA patients receiving GA through laryngeal mask airway
      (LMA) versus spinal anesthesia.
    

Detailed description: 
      Nausea after surgery may negatively influence patient satisfaction, may delay discharge, and
      cause unexpected hospital admissions. The trend toward ambulatory surgery has increased the
      focus on postoperative nausea, but published evidence is not based on standardized criteria
      for assessment. Therefore, the results for postoperative nausea are very diverse, especially
      reports on nausea incidence after regional anesthesia, i.e. spinal anesthesia. This is due to
      varying data sources, such as nurse notes and/or patient reports, and a lack of a consistent
      antiemetic and pain medication protocol. The results of this study will help power a future
      randomized controlled trial, comparing the incidence and intensity of nausea in FA patients
      receiving GA through laryngeal mask airway (LMA) versus spinal anesthesia.

      When peripheral nerve blocks have been applied for postoperative pain control, they
      significantly reduce postoperative pain, opioid consumption and side effects; patients
      receiving GA and nerve blocks are thought likely to have less nausea than patients receiving
      GA alone, due a reduction in pain leading to reduction in need for emetogenic opioids.

      This study is a pilot study looking at the incidence and intensity of nausea after orthopedic
      surgery under nerve blocks in foot and ankle (FA) patients and under nerve blocks with either
      sedation or GA in total shoulder arthroplasty (TSA) patients. At the author's institution,
      TSA is commonly performed with a brachial plexus block and either GA or intravenous sedation.
      TSA patients represent a model system for the effect of GA on nausea among patients receiving
      nerve blocks.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients undergoing elective orthopedic surgery for foot and ankle or total shoulder
        replacement that are within the age limit and meet eligibility criteria.