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PAIN AND NAUSEA AND VOMITING IN AMBULATORY LUMBAR DISCECTOMY

^* Department of Anesthesia,
^# Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St., Toronto, Ontario, Canada, M5T 2S8

INTRODUCTION

Currently in North America, 65% of the surgical procedures are carried out in ambulatory settings. Microsurgical discectomy can be performed as an ambulatory procedure. A retrospective chart review was done to document factors that delayed discharge or led to unanticipated admission.

METHODS

After Institutional Review Board (IRB) approval, the hospital medical records of 106 patients who underwent microsurgical discectomy on an ambulatory basis were reviewed. A single surgeon at the Toronto Western Hospital operated on all patients. Preoperative, intraoperative and postoperative data was collected on specifically designed data sheets. All anesthetic and surgical factors that affected discharge were noted.

RESULTS

Of the 106 patients reviewed, only 6 (5.7%) were unanticipated admissions. Two patients were admitted due to nausea and vomiting, one due to severe pain, one due to urinary retention and 2 were surgical causes, recurrent disc herniation and dural tear. Eight patients (7.5%) had delayed discharge. One patient had delayed discharge due to severe nausea, one due to severe pain, two patients complained of dry eyes and required ophthalmology consult, one severe sore throat, and one due to low oxygen saturation. Two patients had surgical causes, one due to bleeding from surgical site and the other due to persistent leg weakness. Sixty-one percent of patients (65/106) complained of nausea in PostAnesthesia Care Unit (PACU). Of these, 16% (17/106) complained of severe nausea requiring treatment with antiemetics. Postoperative vomiting was observed in 9.4% (10/106) patients. A significant number of patients, 75.4% (80/106), complained of pain in PACU. Of these, 33.9% (36/106) patients had VAS scores more than 6 and required intravenous analgesics.

DISCUSSION

Ambulatory lumbar microdiscectomy can be safely carried out as an ambulatory procedure with a low unanticipated admission rate, 5.7%. However a significant number of patients had severe pain or nausea and vomiting. Better intraoperative pain and antiemetic management is warranted in these patients.

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