Risk factors for pain and nausea following retinal and vitreous surgery under conscious sedation

Background: There have been no studies examining risk factors for pain and nausea during the first day after posterior segment surgery. We performed a study to identify significant risk factors for the development of pain and nausea during the first 24 hours after outpatient vitrectomy or scleral bu ckle surgery. Methods: A total of 257 consecutive patients who underwent vitrectomy (192 patients), scleral buckling (57 patients) or combined vitrectomy-scleral bu ckling (8 patients) between July I and Dec. 31, 1995, were enrolled in this prospective study. The patients' age, sex and ethnicity, the duration of t he procedure and the intraoperative use of minor tranquillizers, hypnotic a gents, narcotic analgesics or major tranquillizers were recorded, Each pati ent rated his or her postoperative pain and nausea on two separate 100-mm l ines. The left end of the line represented no pain (or nausea) whatsoever, and the right end of the line represented severe pain (or nausea). The dist ance of the recorded point from the origin of the line was used as the outc ome measure for pain and nausea. All the data were analysed statistically b y means of logistic regression analysis and descriptive statistics. Results: The median pain scores were 1.0 for the patients who underwent vit rectomy, 47.0 for those who underwent scleral buckling and 35.0 for those w ho underwent combined vitrectomy-scleral buckling. The median nausea scores were 14.5, 45.0 and 55.5 respectively. The only variable that was identifi ed as a predictor of postoperative pain or nausea was the intraoperative us e of narcotic analgesics: in the vitrectomy group, postoperative nausea occ urred almost three times as often among patients who received these agents as among those who did not (odds ratio 2.6, p = 0.00).