Exploring the multifactorial nature of postoperative nausea and vomiting in women following surgery for breast cancer

Abstract

Background Postoperative nausea and vomiting (PONV) are two of the most frequent and distressing complications following surgical procedures, with as many as 80% of patients considered to be at risk. Despite recognition of well-established risk factors and the subsequent use of clinical guidelines, 20–30% of women do not respond to antiemetic protocols, indicating that there may be a genetic risk. Objective The purpose of this pilot study was to describe the incidence and explore the risk factors associated with PONV after surgery in women diagnosed with early stage breast cancer. Methods A prospective cohort design was employed to measure PONV in women recruited prior to surgery. DNA was extracted from saliva samples collected prior to discharge. Polymorphisms for seven candidate genes with a known role in one of the neural pathways associated with PONV were included in this study; serotonin receptor (HTR3A), serotonin transport (SLC6A4), tryptophan (TPH), dopamine receptors (DRD2/ANKK and DRD3), catechol-O-methyltransferase (COMT) and histamine (H1). Results Twenty-nine (29.8%) women experienced nausea and 10 (11%) experienced nausea and vomiting while in the PACU despite administration of multiple antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experienced PONV. Odds ratios demonstrated that alleles for the COMT, DRD3, and TPH genes were associated with decreased PONV. Conclusion The understanding of the multifactorial nature of PONV and the recognition of genetic risk will ultimately lead to the development of personalized interventions to manage these frequent and often debilitating symptoms.

Postoperative Nausea and Vomiting: Risks, Prophylaxis, Non-Drug Alternative Methods

“…Disadvantages of PONV include the discomfort in the patient, prolonged length of hospital stay, and delays in recovery (Çekmen et al,2003). Besides these untoward consequences, severe PONV is associated with consequent fluid and electrolyte loss, aspiration into airways, contamination of the surgical site, increased strain in the sutured incision site, and increased intraocular and intraabdominal pressure (Kayhan Z ,2004;Wesmiller et al,2017).…”

Risk-tailored prophylaxis for postoperative nausea and vomiting: still a messy issue

“…Genetic-association studies exploring the response to opioids after surgery reported not only on analgesic effects, but also on opioid-induced nausea and vomiting (OINV), 7 and on the response to 5-HT3 serotonin receptor antagonist anti-emetic drugs in the context of general inhalation anaesthesia. 8e14 In particular, the OPRM1 gene that encodes several mu-opioid receptor isoforms has been extensively studied in the context of OINV and PONV, 7,15e18 along with numerous SNPs of the 5-HT3A and 5-HT3B serotonin receptor genes (HTR3A and HTR3B), 19e21 the serotonin transport gene (SLC6A4), 22 the organic cation transporter-1 gene (OCT1), 23 the dopamine D2 receptor gene (DRD2), 24 the catechol-o-methyl-transferase gene (COMT), 25,26 the adenosine triphosphate-binding cassette subfamily B member 1 gene (ABCB1), 27 the TACR1 gene that encodes NK1 receptors, 28 and the CYP2D6 isoform of the cytochrome P450 superfamily. 29 This list might not even be exhaustive, and in addition, the response to 5-HT3 serotonin receptor antagonist anti-emetic drugs (e.g.…”

Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial

“…The four risk factors included in the Apfel Risk Score are female sex, prior history of motion sickness, or PONV, nonsmoking, and the use of postoperative opioids (2). In addition, elevated levels of distress may increase the severity of PONV (3,4) in the postoperative period. Concerns about changes in appearance and scarring, anesthesia, surgical procedures, diagnosis, and prognosis determine such distress.…”