Post- Surgery Recovery: Nerve Blocks w/ Sedation vs. Nerve Block w/ Either Sedation/Gen. Anesthesia
Post- Surgery Recovery: Nerve Blocks w/ Sedation vs. Nerve Block w/ Either Sedation/Gen. Anesthesia
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.
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.
Inclusion Criteria:

 -  Elective surgery

 -  Age 18-99

 -  Patients who are capable to provide informed consent and answer questions in English,

 -  For FA patients: Planned neuraxial anesthesia + nerve block for postsurgical
 analgesia,

 -  For TSA patients: Planned brachial plexus nerve block + either general anesthesia or
 IV sedation.

 Exclusion Criteria:

 -  Incapable to provide informed consent

 -  Contraindications for regional or LMA anesthesia (anticoagulation, infection at
 injection site)

 -  Anticipated difficult airway

 -  Body mass index>35

 -  Anticipated surgical procedure time less than 1 hour or more than 4 hours,

 -  History of severe postoperative nausea and/or vomiting

 -  American Society of Anesthesiologists physical status classification >3

 -  Neuropathy

 -  Pregnant or nursing women

 -  Chronic opioid use (daily use of opioids one month prior to surgery/ patients
 requiring chronic pain interventions)

 -  Prone position planned for surgery

 -  Obstructive sleep apnea

 -  Known allergy/sensitivity to any study medications