Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

Abstract

Background: Breast augmentation is the plastic surgery procedure associated with the greatest risk of postoperative nausea and vomiting (PONV). The purpose of this study is to evaluate the efficacy of a specific antiemetic protocol applied in breast augmentation in order to diminish the incidence of PONV Methods: A prospective-level of evidence II-study was performed in 247 patients that underwent breast augmentation from October 2010 to October 2014. General anesthesia was induced with propofol, fentanyl and rocuronium. Anesthetic maintenance was accomplished with total intravenous anesthesia and air with oxygen at 50%. All patients received metoclopramide 10 mg intravenously (iv) and 8 mg of ondasetron iv (2 mg at the induction and 6 mg over 30 minutes). Intergroup comparison of means was performed using unpaired t tests and analysis of variance, where applicable.Results: Nausea and emesis occurred with an overall frequency of 4.9% and 2.8% respectively. The 95.1 percent of the patient didn't complaint having nausea on the day of operation, and only 3 (1.2%) of them had this symptom remaining until the fifth post op day. Only 7 patients reported vomiting on the day of the operation. There is no significant difference in nausea between smokers and no smokers (p= 0.510). Conclusion:Τhe specific antiemetic protocol applied in breast augmentation operations seems to be highly effective. The fact that we observed no difference between smokers and nonsmokers regarding the incidence of PONV should be further investigated since till now a protective role for smoking against PONV was suggested. Introduction 1Postoperative nausea and vomiting (PONV) are common adverse effects that occur after several types of surgical procedures. The general incidence of vomiting is about 30%, the incidence of nausea is about 50%, and in high-risk patients, the PONV rate can be as high as 80% [1][2][3]. The mechanism of PONV is multifactorial and not well-deciphered. The emesis reflex is coordinated by the vomiting center, located in the hindbrain within the medulla oblongata in close proximity to the chemoreceptor trigger zone within the area postrema. Stimuli from peripheral organs and tissues, including the genitalia are transmitted to the vomiting center by the afferent neurons of the vagus nerve [4].However, not all patients have the same risk profile for PONV. The incidence of PONV varies with patient-related factors, the nature of surgery performed, type of anesthesia used, and duration of surgery and perioperative management of the patient (Table 1) [5]. The risk of PONV in adult women has been found to be two to three times greater than in adult men. Progesterone 1 Presented:1) The 12th Congress of the ESPRAS -July 6-11, 2014, Edinburgh, Scotland.2) 22nd Congress of the ISAPS -September 19-22, 2014 Rio de Janeiro, Brazil.3) Accepted for presentation in Euroanaesthesia 2016 London UK May 28-30. or serum gonadotropin seem to be the contributing factor in the higher incidence of PONV in women [5,6]. Furthermore, obese p...

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

“…No subjects experienced delayed hospital discharge, remained in the hospital after surgery due to PONV or were admitted after discharge due to delayed PONV (DPONV). The overall and between-group incidence of PONV in this study is lower than the prevalence reported in recent literature for ambulatory surgery ( 49 , 50 ) and specifically for breast surgery ( 35 , 45 , 51 , 52 ). The fact that opioid consumption in our study was comparable between groups most likely did not allow for a significant inter-group difference in PONV.…”