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.