J Anesth (2005) 19:323–324 DOI 10.1007/s00540-005-0337-x Immediate postoperative refeeding in orthopedic surgery is safe Thomas Rimmelé 1 , Emmanuel Combourieu 2 , Pierre-François Wey 2 , Emmanuel Boselli 1 , Bernard Allaouchiche 1 , Dominique Chassard 1 , and Jacques Escarment 2 1 Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, 5 Place d’Arsonval, 69003 Lyon, France 2 Anesthesiology and Critical Care Medicine, Desgenettes Teaching Military Hospital, Lyon, France January and December 2003 at our teaching military hospital. After surgery, all patients were permitted to drink and eat immediately after discharge from the postanesthetic care unit when they returned to their hospital rooms. Postoperative nausea and vomiting, deglutition trouble, and complications linked to re- gurgitation and aspiration were recorded during the first 48 h. Patients and methods One thousand and seventy-seven patients, American Society of Anesthesiologists (ASA) physical status I–IV, were included in the study. The patient popula- tion was composed of 59% men (n = 635) and 41% women (n = 442), with a mean ± SD age of 49 ± 20 years (range, 14 to 93 years). General anesthesia was per- formed in 37% of the patients (n = 398), 24% (n = 259) had combined general and regional anesthesia, 8% (n = 86) had isolated spinal anesthesia, 3% (n = 32) had combined spinal and peripheral block anesthesia, and 28% (n = 302) had peripheral regional anesthesia. The types of orthopedic surgery included total and partial hip replacement, total knee replacement, shoulder sur- gery, carpal tunnel syndrome surgery, upper and lower limb fractures and luxations, disk hernia, hand micro- surgery, orthopedic material ablations, arthroscopies, and ligamentoplasties. Peripheral block anesthesia included continuous and single-shot brachial plexus blocks, sciatic nerve blocks, and lumbar plexus blocks. When general anesthesia was carried out, propofol was used for induction and sevoflurane was used for maintenance of anesthesia. Remifentanil, sufentanil, or alfentanil were used as opioids. No nitrous oxide was used during anesthesia management. No systematic nausea and vomiting prophylaxis was performed. Only those patients (n = 54) who reported an antecedent episode of postoperative nausea and vomiting received Address correspondence to: T. Rimmelé Received: November 22, 2004 / Accepted: May 23, 2005 Abstract The purpose of this retrospective study was to investigate the morbidity of immediate postoperative refeeding after ortho- pedic surgery. We included all the 1077 patients who under- went orthopedic surgery between January and December 2003 at our military teaching hospital. General anesthesia was performed in 37% of the patients (n = 398), 24% (n = 259) had combined general and regional anesthesia, and 39% (n = 420) had isolated regional anesthesia (spinal anesthesia and/or pe- ripheral regional anesthesia). After surgery, each patient was allowed free access to solid and liquid food immediately after discharge from the postanesthetic care unit. Although no sys- tematic nausea and vomiting prophylaxis was performed, only 7% (n = 75) of the patients had postoperative nausea and vomiting during the first 48 h. Moreover, neither deglutition trouble nor aspiration syndrome was observed during that period. Our results suggest that immediate postoperative refeeding after orthopedic surgery is safe, does not increase postoperative nausea and vomiting, and probably increases the comfort of patients. Key words Early oral intake · Postoperative nausea and vom- iting · Regional anesthesia Introduction After nonabdominal surgery, postoperative refeeding is generally allowed by anesthesiologists about 4 to 6 h after the patient is discharged from the postanesthetic care unit. With this practice, anesthesiologists aim at decreasing the aspiration risk linked to postoperative deglutition trouble. However, this common practice is not based on recommendations, and the medical litera- ture is hopelessly blank concerning this topic. We con- ducted a retrospective, single-center survey on all the patients who underwent orthopedic surgery between