Prophylaxis of postoperative nausea and vomiting in elective breast surgery

Voigt, Matthias; Fröhlich, C; Waschke, Klaus F.; Lenz, Christian; Göbel, U.; Kerger, Heinz

doi:10.1016/j.jclinane.2011.01.005

Cited by 29 publications

(22 citation statements)

References 51 publications

(74 reference statements)

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“…This is in line with previous studies using the closely structural related long acting glucocorticoid steroid dexamethasone, which have an analogous late antiemetic efficacy [5,14]. Furthermore, the present study showed that an antiemetic effect only was detected when NRS levels for nausea was set as low as 1, which may be argued of its relevance in clinical practice.…”

Section: Discussionsupporting

confidence: 92%

Betamethasone in prevention of postoperative nausea and vomiting following breast surgery

Olanders

Lundgren

Johansson

2014

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 92%

Betamethasone in prevention of postoperative nausea and vomiting following breast surgery

Olanders

Lundgren

Johansson

2014

Journal of Clinical Anesthesia

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“…Avoiding intubation by using supraglottic airways or by adopting regional anesthesia may decrease this airway discomfort. Besides, early recovery was more comfortable in PVB group probably due to a significantly infrequent PONV by virtue of using propofol infusion and avoidance of desflurane [26].…”

Section: Discussionmentioning

confidence: 99%

Anything Other than Pain that Matters after Breast Cancer Surgery? A Randomized Controlled Study Comparing Three Anesthetic Modalities

Li¹,

Chen²

2014

Surgery

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Background: Paravertebral block (PVB) was shown to reduce postoperative pain and postoperative nausea and vomiting for breast surgery. However, there is no evidence showing that these benefits were solely provided by PVB and positively influence patient-perceived outcomes after breast cancer surgery. Methods:One hundred breast cancer patients were randomized into three groups: general anesthesia (GA, n=34), GA with PVB (GA+ PVB, n=33), PVB with sedation (PVB, n=33). The quality of recovery (QoR) score was assessed preoperatively as baseline, 6 hours postoperatively, and on postoperative day (POD) 1. Analgesia effects, adverse events, and perioperative satisfactions were also assessed. Results:The rate of QoR 6 hours reaching 18 in GA group (25.53%) seemed to be lower compared with GA+PVB (30.3%) or PVB (42.42%) but without statistical significance. Nevertheless, multivariate logistic regression analysis demonstrated that modality of PVB affected QoR 6 hours (p=0.04). Analgesic consumptions and pain scores were significantly higher and time to first request of analgesics shorter in GA group. The incidences of the GA-related undesired effects were significantly lower and satisfaction with emergence significantly better (P < 0.0001) in PVB group when compared with GA group. There was no difference between GA and GA+PVB in these outcomes. Conclusions:Anesthesia modalities containing PVB provided better pain control. Anesthesia modalities avoiding GA, i.e. PVB alone, led to significantly lower incidences of GA-related adverse events, significantly better satisfaction with the process of emergence, and contribution to QoR 6hours reaching 18.

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“…Without prophylactic antiemetic therapy, 48 to 70% of female patients undergoing breast surgery will suffer from early postoperative nausea and vomiting (PONV) [1–3] and require post-anesthesia care unit (PACU) rescue antiemetic administration. Current PONV consensus guidelines advocate multimodal prophylactic antiemetic therapy for higher risk patients [4].…”

Section: Introductionmentioning

confidence: 99%

“…Generally agreed upon risk factors include gender, smoking status (smokers versus nonsmokers), previous history of PONV or motion sickness (HxPONV/MS), PACU opioid usage, and type/anatomical location of surgery [4–6]. Multimodal prophylactic antiemetic therapy has shown to greatly reduce the incidence of PONV [2, 3]. There is debate surrounding the use of multimodal prophylactic therapy based on risk factors [7–10].…”

Section: Introductionmentioning

confidence: 99%

Phenothiazine vs 5HT3 Antagonist Prophylactic Regimens to Prevent Post‐Anesthesia Care Unit Rescue Antiemetic: An Observational Study

Ruíz

Ensor

Lim

et al. 2015

OJAnes

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Purpose Our practitioners are asked to consider a patient’s postoperative nausea and vomiting (PONV) risk profile when developing their prophylactic antiemetic strategy. There is wide variation in employed strategies, and we have yet to determine the most effective PONV prophylactic regimen. The objective of this study is to compare prophylactic antiemetic regimens containing: phenothiazines to 5HT3 antagonists for effectiveness at reducing the incidence of Post-Anesthesia Care Unit (PACU) rescue antiemetic administration. Methods This is an observational study of 4,392 nonsmoking women who underwent general anesthesia for breast surgery from 1/1/2009 through 6/30/2012. Previous history of PONV or motion sickness (HxPONV/MS) and the use of PACU opioids were recorded. Prophylactic antiemetic therapy was left to the discretion of the anesthesia care team. We compared phenothiazines and 5HT3 antagonists alone and with a glucocorticoid to determine the most effective treatment regimen in our practice for the prevention of the administration of PACU rescue antiemetics. Results Patients who received a phenothiazine regimen compared to a 5HT3 antagonist regimen were less likely to have an antiemetic administered in the PACU (p=0.0100) and this significant difference in rates holds in a logistic regression model adjusted for HxPONV/MS and PACU Opioid use (p=0.0103). Conclusions Based on our findings our clinicians are encouraged to administer a combination of a phenothiazine and a glucocorticoid in female, nonsmoking surgical breast patients for the prevention of PACU rescue antiemetic administration.

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Prophylaxis of postoperative nausea and vomiting in elective breast surgery

Cited by 29 publications

References 51 publications

Betamethasone in prevention of postoperative nausea and vomiting following breast surgery

Betamethasone in prevention of postoperative nausea and vomiting following breast surgery

Anything Other than Pain that Matters after Breast Cancer Surgery? A Randomized Controlled Study Comparing Three Anesthetic Modalities

Phenothiazine vs 5HT3 Antagonist Prophylactic Regimens to Prevent Post‐Anesthesia Care Unit Rescue Antiemetic: An Observational Study

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