A Radiologia tem sido considerada uma das áreas da Medicina que mais se desenvolve, especialmente com o aporte de novas tecnologias. Entre as aplicações da Radiologia Intervencionista destaca-se a utilização da fluoroscopia no centro cirúrgico em complemento às cirurgias ortopédicas, objeto da presente pesquisa. Entretanto, alguns complexos e longos procedimentos guiados fluoroscopicamente podem resultar em altos níveis de exposição ocupacional às radiações ionizantes para equipe de cirurgia ortopédica e trabalhadores de saúde, induzir sérios danos à saúde. Levando em conta esses aspectos, o objetivo geral dessa pesquisa consiste em determinar a exposição ocupacional da equipe de cirurgia ortopédica em procedimentos guiados por fluoroscopia e verificar dentre as cirurgias observadas a que oferece maior exposição ocupacional às radiações ionizantes, como também, a aplicação dos princípios básicos de proteção radiológica nestes procedimentos. A metodologia utilizada para essa pesquisa foi a qualiquantitativa do tipo exploratória. A pesquisa foi realizada no Hospital de Clínicas da Universidade Federal de Curitiba (UFPR). Os sujeitos pesquisados foram os membros da equipe de cirurgia ortopédica, ou seja, médicos ortopedistas, residentes, anestesias, instrumentador cirúrgico, técnicos e auxiliares de enfermagem, e enfermeiros. A coleta de dados foi realizada de 01 de janeiro a 30 de maio de 2011. Contribuíram para a pesquisa, 44 trabalhadores que responderam uma entrevista coletiva, e um questionário com 25 perguntas fechadas. foi constituídos quatro grupos de onze participantes cada, seguida de análise documental e de monitoração da área pesquisada e individual. Os resultados mostraram que os profissionais de saúde do setor pesquisado expõem-se às radiações ionizantes, devido à demanda de cirurgias guiadas por equipamentos emissores de radiação ionizantes fluoroscopicamente, e a falta de conhecimento em radioproteção. Diante dessas constatações foram sugeridas pelos grupos medidas de prevenção a essas exposições de modo a minimizar possíveis efeitos biológicos das radiações ionizantes. Foi concluído que existe exposição ocupacional com os trabalhadores do setor pesquisado, os mesmos tem pouco conhecimento quanto ao uso dos equipamentos de radioproteção nos procedimentos cirúrgicos com equipamentos emissores de radiações ionizantes, não usam corretamente os monitores individuais. / Radiology has been considered one of the areas of medicine that most devel-ops, especially with the contribution of new technologies. Among the applications of Interventional Radiology highlights the use of fluoroscopy in the surgical center in addition to co-orthopedic surgeries, the object of the present research. Entretan-to some complex and lengthy fluoroscopically guided procedures can result in high levels of occupational exposure to ionizing radiation for e-quipe orthopedic surgery and health workers, induce serious damage to health. Considering these aspects, the general objective of this research is to de-termine the occupational exposure of the team of orthopedic surgery proce-dures guided by fluoroscopy and verify observed among the surgeries that offer greater occupational exposure to ionizing radiation, but also the application of basic principles of radiological protection in these procedures. The methodology for this research was the qualitative and quantitative exploratory type. The research was conducted at Hospital de Clinicas, Federal University of Curitiba (UFPR). Study subjects were members of the team of orthopedic surgery, or orthopedic doctors, residents, anesthesia, surgical instrumentator, technicians and nursing assistants, and nurses. Data collection was performed from January 1 to May 30, 2011. Contributors to the survey, 44 workers who answered a news conference, and a questionnaire with 25 closed questions of. was divided in four groups of eleven participants each, followed by document analysis and monitoring of the area and searched individually. The results we-strated that the health sector professionals surveyed were exposed to ionizing radiation, due to demand-driven surgery equipment emitting ionizing radiation fluoroscopically, and the lack of knowledge in radioprote-tion. Before these findings were suggested by the groups pre-vention measures of these exposures to minimize possible biological effects of ionizing radiation-tions. It was concluded that occupational exposure exists with re-worked in the sector researched, they have little knowledge about the use of radiation protection equipment in surgical procedures with equipment emitting ionizing radiation, properly use the monitors indi-tions.

A Radiologia tem sido considerada uma das áreas da Medicina que mais se desenvolve, especialmente com o aporte de novas tecnologias. Entre as aplicações da Radiologia Intervencionista destaca-se a utilização da fluoroscopia no centro cirúrgico em complemento às cirurgias ortopédicas, objeto da presente pesquisa. Entretanto, alguns complexos e longos procedimentos guiados fluoroscopicamente podem resultar em altos níveis de exposição ocupacional às radiações ionizantes para equipe de cirurgia ortopédica e trabalhadores de saúde, induzir sérios danos à saúde. Levando em conta esses aspectos, o objetivo geral dessa pesquisa consiste em determinar a exposição ocupacional da equipe de cirurgia ortopédica em procedimentos guiados por fluoroscopia e verificar dentre as cirurgias observadas a que oferece maior exposição ocupacional às radiações ionizantes, como também, a aplicação dos princípios básicos de proteção radiológica nestes procedimentos. A metodologia utilizada para essa pesquisa foi a qualiquantitativa do tipo exploratória. A pesquisa foi realizada no Hospital de Clínicas da Universidade Federal de Curitiba (UFPR). Os sujeitos pesquisados foram os membros da equipe de cirurgia ortopédica, ou seja, médicos ortopedistas, residentes, anestesias, instrumentador cirúrgico, técnicos e auxiliares de enfermagem, e enfermeiros. A coleta de dados foi realizada de 01 de janeiro a 30 de maio de 2011. Contribuíram para a pesquisa, 44 trabalhadores que responderam uma entrevista coletiva, e um questionário com 25 perguntas fechadas. foi constituídos quatro grupos de onze participantes cada, seguida de análise documental e de monitoração da área pesquisada e individual. Os resultados mostraram que os profissionais de saúde do setor pesquisado expõem-se às radiações ionizantes, devido à demanda de cirurgias guiadas por equipamentos emissores de radiação ionizantes fluoroscopicamente, e a falta de conhecimento em radioproteção. Diante dessas constatações foram sugeridas pelos grupos medidas de prevenção a essas exposições de modo a minimizar possíveis efeitos biológicos das radiações ionizantes. Foi concluído que existe exposição ocupacional com os trabalhadores do setor pesquisado, os mesmos tem pouco conhecimento quanto ao uso dos equipamentos de radioproteção nos procedimentos cirúrgicos com equipamentos emissores de radiações ionizantes, não usam corretamente os monitores individuais. / Radiology has been considered one of the areas of medicine that most devel-ops, especially with the contribution of new technologies. Among the applications of Interventional Radiology highlights the use of fluoroscopy in the surgical center in addition to co-orthopedic surgeries, the object of the present research. Entretan-to some complex and lengthy fluoroscopically guided procedures can result in high levels of occupational exposure to ionizing radiation for e-quipe orthopedic surgery and health workers, induce serious damage to health. Considering these aspects, the general objective of this research is to de-termine the occupational exposure of the team of orthopedic surgery proce-dures guided by fluoroscopy and verify observed among the surgeries that offer greater occupational exposure to ionizing radiation, but also the application of basic principles of radiological protection in these procedures. The methodology for this research was the qualitative and quantitative exploratory type. The research was conducted at Hospital de Clinicas, Federal University of Curitiba (UFPR). Study subjects were members of the team of orthopedic surgery, or orthopedic doctors, residents, anesthesia, surgical instrumentator, technicians and nursing assistants, and nurses. Data collection was performed from January 1 to May 30, 2011. Contributors to the survey, 44 workers who answered a news conference, and a questionnaire with 25 closed questions of. was divided in four groups of eleven participants each, followed by document analysis and monitoring of the area and searched individually. The results we-strated that the health sector professionals surveyed were exposed to ionizing radiation, due to demand-driven surgery equipment emitting ionizing radiation fluoroscopically, and the lack of knowledge in radioprote-tion. Before these findings were suggested by the groups pre-vention measures of these exposures to minimize possible biological effects of ionizing radiation-tions. It was concluded that occupational exposure exists with re-worked in the sector researched, they have little knowledge about the use of radiation protection equipment in surgical procedures with equipment emitting ionizing radiation, properly use the monitors indi-tions.

O insucesso nos procedimentos cirúrgicos ortopédicos em razão de infecção pode levar a consequências desastrosas como a osteomielite e a perda de próteses implantadas. A infecção hospitalar é um desfecho de causa multifatorial, na qual a esterilização segura do instrumental cirúrgico ocupa uma posição de extrema importância. Não se sabe até o momento quais os reais desafios microbiológicos que a Central de Material e Esterilização (CME) vem enfrentando ao reprocessar a diversidade dos materiais utilizados nos procedimentos cirúrgicos. Micro-organismos com capacidade para esporular estão presentes em quantidade e frequência significativa? Sabe-se que estes se constituem como desafio mensurável na prática da esterilização, fazendo parte de indicadores biológicos. O objetivo desta pesquisa foi determinar e analisar a carga microbiana recuperada do instrumental cirúrgico, após uso em cirurgias ortopédicas, quantificando e identificando o gênero e a espécie do crescimento de bactérias e fungos. A investigação caracterizou-se como uma pesquisa exploratória, de campo e transversal com abordagem quantitativa. As amostras foram coletadas no Instituto de Ortopedia e Traumatologia (IOT) do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), com técnica asséptica, depositando-as individualmente em um saco plástico previamente esterilizado, adicionando 500 mL de água de injeção. Para obtenção da carga microbiana, o instrumental foi sonicado em lavadora ultrassônica (US) por três sessões de 5 segundos cada e, consecutivamente, agitado por 5 minutos para complementar a extração da carga microbiana potencialmente presente na superfície dos materiais (externa e internamente). Em seguida, os lavados foram divididos em três partes iguais e submetidos à filtração em filtro Millipore® de 0,45 µm. Cada membrana foi cultivada em meio apropriado para o crescimento aeróbio, anaeróbio e fungos/leveduras. Para a identificação dos micro-organismos, foram utilizados kits e testes de identificação utilizados na rotina laboratorial de microbiologia clínica. Os resultados demonstraram que os três diferentes potenciais de contaminação apresentaram crescimento microbiano. Nas cirurgias limpas, 47% do instrumental estavam contaminados e o micro-organismo mais prevalente foi o Staphylococcus coagulase negativa (28%), seguido do Bacillus subtilis (11%). Nas cirurgias contaminadas e infectadas, houve um crescimento, de aproximadamente, 70% e 80%, respectivamente nos instrumentos, sendo maior o crescimento do Staphylococcus coagulase negativa (respectivamente, 32% e 29%) e Staphylococcus aureus (respectivamente, 28% e 43%). Considerando que os gêneros Bacillus e o Clostridium são capazes de esporularem, concluiu-se que a CME enfrenta um desafio ao precisar eliminar micro-organismos capazes de esporular, em uma densidade 102 UFC, menor que a dos indicadores biológicos e, aproximadamente, 78% dos micro-organismos recuperados foram bactérias vegetativas com sua curva de morte em torno de 80 ºC / The failure in orthopedic surgical procedures due to infection can lead to devastating consequences such as the loss of implanted prostheses. Hospital infection is an outcome with a multifactorial cause, in which the safe sterilization of the surgical instruments has an extremely important role. To date, it is not known what microbiological challenges the Material and Sterilization Center (MSC) has been facing when reprocessing the variety of materials used during these surgical procedures. Are microorganisms with the capacity to sporulate present in significant quantity and frequency? It is known that these microorganisms constitute a measurable challenge in sterilization practice and that they are part of the biological indicators. This study aimed at measuring the microbial load recovered from surgical instruments after their use in orthopedic surgeries, quantifying and identifying the genus and species of the bacterial and fungal growth. The study was characterized as an exploratory research, field research and cross-sectional with quantitative approach. The samples were collected at the Institute of Orthopedics and Traumatology (IOT) of Hospital das Clínicas (HC) of the School of Medicine of the University of São Paulo (FMUSP), using an aseptic technique, the samples were then placed in a plastic bag that had been previously sterilized with 500 mL of injection solution. To obtain the microbial load, the instruments were sonicated in an ultrasonic (US) washer for three 5-second sessions each and consecutively agitated for 5 minutes to complement the extraction of the microbial load potentially present on the surface of the materials (external and internally). Subsequently, the washed samples were fragmented in three equal parts and these were submitted to filtration in a 0.45 µm Millipore® filter. Each membrane was cultured in medium adequate for the growth of aerobic and anaerobic organisms, as well as fungi and yeasts. The identification of the microorganisms was carried out with identification kits and tests used in clinical microbiology laboratory routine. The results demonstrated that the three different contamination potentials presented microbial growth. In clean surgeries, 47% of the instruments were contaminated and the most prevalent microorganism was coagulase-negative Staphylococcus (28%) followed by Bacillus subtilis (11%). In contaminated and infected surgeries, a growth of approximately 70% and 80%, respectively, was identified in the instruments, with the higher growth being that of coagulase-negative Staphylococcus (respectively, 32% and 29%) and Staphylococcus aureus (respectively, 28% and 43%). Considering that the Bacillus and the Clostridium genera are capable of sporulating, we concluded that the MSC faces a challenge in having to eliminate microorganisms capable of sporulating, although in a lower density than that of biological indicators (102 UFC) and, approximately, 78% of the recovered microorganisms were vegetative bacteria that presented their curve of death at around 80ºC

Bakgrund   Muskuloskeletala systemet, även benämnt som rörelseapparaten, kräver alltid postoperativ omvårdnad efter operation i de nedre extremiteterna. En viktig aspekt av vårdprocessen är personcentrerad omvårdnad, som betonar vikten av preoperativ information, postoperativ rehabilitering och aktiv patientmedverkan. Tidig mobilisering efter operation är avgörande för att minska risken för komplikationer och förkorta sjukhusvistelsen, samtidigt som det finns en strävan att förbättra patientens livskvalitet och återställa funktion. Denna studie fokuserar på att analysera den postoperativa vården efter ortopedisk kirurgi. Syfte  Syftet var att belysa postoperativ vård efter ortopedisk kirurgi. Metod  En icke-systematisk litteraturöversikt baserad på 15 vetenskapliga originalartiklar med kvalitativa, kvantitativa eller mixad design. Artiklarna valdes ut från databaserna PubMed och CINAHL. Samtliga artiklar har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Integrerad dataanalys användes för att sammanställa resultatet. Resultat Resultatet sammanställdes med hjälp av två huvudkategorier: Tidig mobilisering och Vårdandets perspektiv. Resultatet visade att tidig mobilisering är fördelaktigt i det tidiga stadiet av postoperativ omvårdnad då det påskyndar rehabiliteringen, förbättrar behandlingsprocessen och sänker vårdkostnaderna. Dessutom framhölls vikten av väl anpassad patientinformation för att stärka den personcentrerade vården. Det är avgörande att vårdgivarna anpassar informationen för att optimera varje patients behandlingsupplevelse och resultat. Slutsats Denna litteraturöversikt understryker vikten av tidig mobilisering efter ortopedisk kirurgi för att påskynda patientens återhämtning, förkorta sjukhusvistelser samt minska smärta, vilket förbättrar både fysiska och psykiska utfall. Genom att implementera ett personcentrerat förhållningssätt som anpassade smärtbehandlingsprotokoll och grundlig preoperativ utbildning kan vårdgivare övervinna hinder som åldersfaktorer och rörelserädsla. Tidig mobilisering, som en del av ERAS-program, visar även ekonomiska fördelar genom minskade vårdkostnader och effektivare resursanvändning, vilket gör det till en kritisk komponent i postoperativ vård. / Background The musculoskeletal system always requires postoperative care after surgery in the lower extremities. An important aspect of the care process is person-centered nursing, which emphasizes the importance of preoperative information, postoperative rehabilitation, and active patient participation. Early mobilization after surgery is essential to reduce risk of complications and shorten the hospital stay, while striving to improve the patient's quality of life and restore function. This study focuses on analyzing the postoperative care after orthopedic surgery. Aim The aim was to shed light on postoperative care after orthopedic surgery. Method A non-systematic literature review based on 15 original scientific articles with a qualitative, quantitative or mixed design. The articles were selected from the databases PubMed and CINAHL. The articles have been quality checked based on Sophiahemmet University's assessment document for scientific classification and quality. Integrated data analysis was used to compile the results. Results The results were compiled with the help of two main categories: Early Mobilization and the Nursing perspective. The result showed that early mobilization is beneficial in the early stage of postoperative care that accelerates rehabilitation, improves the treatment process and lowers costs. Additionally, the importance of well-adapted patient information to strengthen person-centered care was highlighted. It's critical that caregivers adapt the information to optimize each patient's treatment experience and outcomes. Conclusions This literature review highlights the importance of early mobilization after orthopedic surgery to accelerate recovery, shorten hospital stays, and reduce pain, improving both physical and psychological outcomes. Implementing person-centered approaches such as customized pain management protocols and thorough preoperative education, caregivers can overcome barriers like age factors and movement fear. Early mobilization, as part of ERAS, also demonstrates economic benefits through reduced healthcare costs and more efficient resource usage, making it a critical component of postoperative care.

Les transfusions sanguines sont fréquemment employées pour corriger l’anémie secondaire à une arthroplastie de la hanche ou du genou. Il n’y a cependant pas consensus sur les indications de transfuser. La tendance actuelle est d’utiliser une stratégie transfusionnelle restrictive (soit un seuil de 75-80 g/L d’hémoglobine) mais les conséquences d’une telle pratique sur la récupération fonctionnelle et la qualité de vie des patients sont mal connues. Dans un premier temps, nous avons caractérisé la pratique transfusionnelle au Centre hospitalier de l’Université de Montréal (CHUM). Notre hypothèse était que, devant l’imprécision des recommandations, la pratique transfusionnelle serait variable. Une étude rétrospective de 701 dossiers de patients ayant subi une arthroplastie de la hanche ou du genou a été réalisée. Nous avons observé que les transfusions étaient utilisées de la même façon dans les trois hôpitaux et que les médecins basaient leur décision de transfuser principalement sur un seul chiffre, la concentration d’hémoglobine, adoptant une stratégie restrictive. Soixante-six pourcent des patients avaient une concentration d’hémoglobine inférieure à 100 g/L au départ de l’hôpital. Dans un deuxième temps, nous avons évalué l’impact de cette anémie postopératoire sur la récupération fonctionnelle et la qualité de vie des patients. Notre hypothèse était qu’il existe une concentration d’hémoglobine en dessous de laquelle celles-ci sont atteintes. Une étude de cohorte prospective et observationnelle a été menée chez 305 patients regroupés selon leur concentration d’hémoglobine postopératoire. Les groupes d’hémoglobine (≤ 80, 81-90, 91-100 et > 100 g/L) étaient similaires dans l’évolution de la distance de marche en six minutes, de l’évaluation de l’effort fourni, de la force de préhension et des scores de qualité de vie. L’anémie modérée n’est donc pas associée à une atteinte de la récupération fonctionnelle et de la qualité de vie à court terme. D’autres études devront déterminer les conséquences à long terme d’une stratégie transfusionnelle restrictive sur ces patients. / Red blood cell transfusions are frequently used to treat anemia after total hip or knee arthroplasties. The indications for transfusions remain unclear despite published guidelines. Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) but the consequences of such a strategy on functional outcome and quality of life are not known. First, we characterized the transfusion practice inside the Centre hospitalier de l’Université de Montréal (CHUM). Our hypothesis was that transfusion practice varies inside the CHUM due to uncertainty. A retrospective study of 701 charts of patients operated for a hip or knee arthroplasty was conducted. We observed that there was no difference among hospitals regarding the way transfusions are used and that physicians mainly based their decision to transfuse on a single variable, the hemoglobin concentration, adopting a restrictive transfusion strategy. Sixty-six percent of patients had a hemoglobin concentration under 100 g/L after surgery. Second, we evaluated the impact of this postoperative anemia on functional outcome and quality of life. We hypothesized that a threshold hemoglobin concentration exists below which these become impaired. A prospective, observational cohort study was conducted in 305 patients categorized in groups according to their postoperative hemoglobin concentration. Hemoglobin groups (≤ 80, 81-90, 91-100 and > 100 g/L) were similar in the evolution of the distance walked in six minutes, perception of effort, maximal dominant hand strength and quality of life scores. Thus, moderate anemia is not associated with an impaired functional recovery or quality of life early after hip and knee arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.

Les transfusions sanguines sont fréquemment employées pour corriger l’anémie secondaire à une arthroplastie de la hanche ou du genou. Il n’y a cependant pas consensus sur les indications de transfuser. La tendance actuelle est d’utiliser une stratégie transfusionnelle restrictive (soit un seuil de 75-80 g/L d’hémoglobine) mais les conséquences d’une telle pratique sur la récupération fonctionnelle et la qualité de vie des patients sont mal connues. Dans un premier temps, nous avons caractérisé la pratique transfusionnelle au Centre hospitalier de l’Université de Montréal (CHUM). Notre hypothèse était que, devant l’imprécision des recommandations, la pratique transfusionnelle serait variable. Une étude rétrospective de 701 dossiers de patients ayant subi une arthroplastie de la hanche ou du genou a été réalisée. Nous avons observé que les transfusions étaient utilisées de la même façon dans les trois hôpitaux et que les médecins basaient leur décision de transfuser principalement sur un seul chiffre, la concentration d’hémoglobine, adoptant une stratégie restrictive. Soixante-six pourcent des patients avaient une concentration d’hémoglobine inférieure à 100 g/L au départ de l’hôpital. Dans un deuxième temps, nous avons évalué l’impact de cette anémie postopératoire sur la récupération fonctionnelle et la qualité de vie des patients. Notre hypothèse était qu’il existe une concentration d’hémoglobine en dessous de laquelle celles-ci sont atteintes. Une étude de cohorte prospective et observationnelle a été menée chez 305 patients regroupés selon leur concentration d’hémoglobine postopératoire. Les groupes d’hémoglobine (≤ 80, 81-90, 91-100 et > 100 g/L) étaient similaires dans l’évolution de la distance de marche en six minutes, de l’évaluation de l’effort fourni, de la force de préhension et des scores de qualité de vie. L’anémie modérée n’est donc pas associée à une atteinte de la récupération fonctionnelle et de la qualité de vie à court terme. D’autres études devront déterminer les conséquences à long terme d’une stratégie transfusionnelle restrictive sur ces patients. / Red blood cell transfusions are frequently used to treat anemia after total hip or knee arthroplasties. The indications for transfusions remain unclear despite published guidelines. Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) but the consequences of such a strategy on functional outcome and quality of life are not known. First, we characterized the transfusion practice inside the Centre hospitalier de l’Université de Montréal (CHUM). Our hypothesis was that transfusion practice varies inside the CHUM due to uncertainty. A retrospective study of 701 charts of patients operated for a hip or knee arthroplasty was conducted. We observed that there was no difference among hospitals regarding the way transfusions are used and that physicians mainly based their decision to transfuse on a single variable, the hemoglobin concentration, adopting a restrictive transfusion strategy. Sixty-six percent of patients had a hemoglobin concentration under 100 g/L after surgery. Second, we evaluated the impact of this postoperative anemia on functional outcome and quality of life. We hypothesized that a threshold hemoglobin concentration exists below which these become impaired. A prospective, observational cohort study was conducted in 305 patients categorized in groups according to their postoperative hemoglobin concentration. Hemoglobin groups (≤ 80, 81-90, 91-100 and > 100 g/L) were similar in the evolution of the distance walked in six minutes, perception of effort, maximal dominant hand strength and quality of life scores. Thus, moderate anemia is not associated with an impaired functional recovery or quality of life early after hip and knee arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.

No description available.

The incidence of postoperative nausea and vomiting (PONV) is unknown in neuraxial anesthesia for orthopedic surgery. The effect on PONV of adding gabapentin to an evidence-based antiemetic regimen as part of an opioid-sparing analgesic protocol is also unknown in this population. A retrospective analysis of all adults undergoing hip and knee arthroplasty and receiving neuraxial anesthesia in 2017 was conducted. The overall incidence of PONV was assessed. Additionally, PONV incidence was assessed for all combinations of gabapentin, dexamethasone, and/or ondansetron (in addition to propofol infusion) and compared with propofol alone. The PONV risk ratios were estimated, adjusting for age and PONV risk score. The overall incidence of PONV was 14.0%. The addition of gabapentin to propofol was associated with reduced PONV (multivariable risk ratio [mRR], 0.6; 95% CI, 0.4-1.0) vs propofol alone. Dexamethasone with propofol was associated with reduced PONV (mRR 0.6; 95% CI, 0.4-1.1) vs propofol alone, although not statistically significant. The addition of both gabapentin and dexamethasone to propofol was associated with stronger reduction in PONV (mRR 0.3; 95% CI, 0.1-0.7) vs propofol alone. Adding ondansetron to propofol showed little benefit. Gabapentin and dexamethasone are effective in reducing PONV in patients undergoing knee and hip arthroplasty with neuraxial anesthesia.