Betamethasone in Prevention of Postoperative Nausea and Vomiting Following Breast Surgery

Olanders, Knut; Lundgren, Gerd A. E.; Johansson, Anders

doi:10.1097/01.sa.0000460963.12309.4a

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…Aasboe et al 182 compared betamethasone 12 mg intramuscularly (IM) to saline when administered 30 minutes before the start of surgery and reported that betamethasone reduced both postoperative pain and nausea in outpatients undergoing ambulatory foot (hallux valgus) surgery or hemorrhoid procedures. Comparable results were attained in patients undergoing ambulatory surgery 183 and elective breast surgery 184 and in high-risk cardiac surgical patients 185 . However, in a placebo-controlled study by Nordin et al 186 comparing betamethasone 8 mg per os (PO) and betamethasone 8 mg IV when administered 1 hour before induction of anesthesia in patients undergoing elective Roux-y-gastric bypass, betamethasone was of limited benefit in preventing PONV.…”

Section: Tricyclic Antidepressantsmentioning

confidence: 97%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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Section: Tricyclic Antidepressantsmentioning

confidence: 97%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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“…Our study has some limitations. First, we adhered to a strict anesthesia protocol that is probably unlike the protocols used in the few controlled clinical trials available on this topic (15)(16)(17)(18). For example, all patients had a physical status of ASA class I or II and were aged <70 years.…”

Section: Discussionmentioning

confidence: 99%

“…One study reported that administration of 8 mg dexamethasone resulted in a marked reduction in PONV after breast cancer surgery (16). Another study analyzing the efficacy of 8 mg betamethasone on the incidence of postoperative complications in 75 patients undergoing breast surgery with and without axillary lymph node dissection reported an 11% reduction in the cumulative incidence of PONV and a 40% reduction in postoperative pain compared with controls (17). However, these studies did not assess the respiratory effects of dexamethasone.…”

Section: Introductionmentioning

confidence: 99%

Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial

et al. 2020

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Background: Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer.Methods: In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. Results:The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. Conclusions:This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs.

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“…Another limitation of our study was the administration of inhalation anesthesia instead of TIVA and/or combination of opioid-free regional anesthesia with TIVA as a part of multimodal analgesia management plan. [17][18][19][20][21] We used inhalation anesthesia because of its cost efficiency and routine preference of our hospital policy.…”

Section: Limitationsmentioning

confidence: 99%

Previous chemotherapy can cause PONV

et al. 2023

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Background.Although the treatment and mechanisms of postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV) are similar, the interactions between these 2 morbidities require more research. Objectives.In our prospective observational study, we investigated whether previous chemotherapy has an effect on PONV in breast cancer surgery. Materials and methods.One hundred and forty-eight female patients with the American Society of Anesthesiologists (ASA) physical status I or II, aged 18-65 years and with a scheduled breast cancer surgery were recruited into the study. After they completed preoperative follow-up questionnaires, anesthesia was induced with propofol (2 mg/kg), remifentanil (1.0 μg/kg) and rocuronium (0.6 mg/kg), and maintained with sevoflurane (1.5-2.0%), 45% oxygen/air mixture and infusion of remifentanil (0. 1-0.2 μg/kg/min). After extubation, the intensity of PONV was assessed during the first 2 h and at 2-24 h after surgery. The symptoms of PONV were classified as mild (mild nausea, vomiting once, and nausea caused by an external stimulant (eating, drinking or motion)), moderate (vomiting twice, mild nausea without an external stimulant, and antiemetic medication required once) and severe (vomiting more than twice, severe nausea, antiemetic medication required more than once) by a different researcher. Preoperative interview forms, perioperative anesthetic follow-up forms and postoperative assessment forms were recorded and evaluated by different members of this research group.Results. Data of 143 patients were analyzed. In the group of patients who received chemotherapy, the prevalence of nausea and vomiting within the postoperative period of 2-24 h significantly increased (p < 0.05).Conclusions. Previous chemotherapy may be a risk factor for the presence of PONV.

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Betamethasone in Prevention of Postoperative Nausea and Vomiting Following Breast Surgery

Cited by 4 publications

References 12 publications

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial

Previous chemotherapy can cause PONV

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