Role of Apfel’s Score in Predicting Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy
Abstract
Introduction: Incidence of post-operative nausea
and vomiting (PONV) following laparoscopic
surgery under general anesthesia ranges from 50-
70% depending on surgical and patient related
factors. Several PONVrisk scores are available,
among which Apfel’s score considers four risk
factors which includes 1) female gender, 2) previous
history of motion sickness or post-operative nausea
and vomiting, 3) nonsmoking status 4) use of
postoperative opioids.
Materials and Methods: A prospective study
was conducted from December 2011 to January
2013 on all patients undergoing laparoscopic
cholecystectomy, without the use of prophylactic
anti-emetics to predict postoperative nausea
and vomiting using Apfel’s score. Perioperative
anesthetic care was standardized in all patients.
Rescue opioid analgesic (Pethidine) was given if
not relived by standardized analgesics. Patients
were thenobserved for PONV for 24 hours. Those
who suffered from PONV received appropriate
anti-emetics if required.
Results: Total 122 patients underwent laparoscopic
cholecystectomy during the study period. Female to
male ratio was 3.2:1. PONV was present in 49.2%
of patients. In our study the predictive percentage
of patients suffering from PONV for scores 0, 1, 2,
3 and 4 were 0%, 11.1%, 46.6%, 66.6% and 70%
respectively. P value was significant with all factors
except previous history of PONV/motion sickness.
Conclusion: In our study, Apfel’s score was found
to be a good predictor for PONV in laparoscopic
cholecystectomy. Out of four risk factors except
previous history of PONV/motion sickness,
remaining were individually statistically significant
in predicting PONV. Those patients with high
Apfel’s score require prophylactic anti-emetics.