Prophylaxis of postoperative nausea and vomiting in elective breast surgery

Abstract Study Objective To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery. Design Prospective, randomized, double-blinded, placebo-controlled trial. Setting University-affiliated hospital. Patients 480 patients with risk factors...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2011-09, Vol.23 (6), p.461-468
Main Authors: Voigt, Matthias, MD, Fröhlich, Christian W., MD, Waschke, Klaus F., MD, Lenz, Christian, MD, Göbel, Ulrich, MD, Kerger, Heinz, MD
Format: Article
Language:English
Subjects:
Adult
Anesthesia
Anesthesia & Perioperative Care
Anesthesia, Inhalation
Anesthesia, Intravenous
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Inhalation - adverse effects
Anesthetics, Intravenous - adverse effects
Anesthetics, volatile
Antiemetic prophylaxis
Antiemetics - therapeutic use
Biological and medical sciences
Breast - surgery
Confidence intervals
Dexamethasone
Dexamethasone - therapeutic use
Dimenhydrinate
Dimenhydrinate - therapeutic use
Double-Blind Method
Drug Therapy, Combination
Female
Haloperidol
Haloperidol - therapeutic use
Humans
Indoles - therapeutic use
Intubation
Male
Medical sciences
Nausea
Pain Medicine
Postoperative nausea and vomiting
Postoperative Nausea and Vomiting - epidemiology
Postoperative Nausea and Vomiting - prevention & control
Postoperative period
Preanesthetic Medication
Prospective Studies
Risk Factors
Statistical analysis
Surgery
Total intravenous anesthesia
Tropisetron
Vomiting
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Summary:Abstract Study Objective To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery. Design Prospective, randomized, double-blinded, placebo-controlled trial. Setting University-affiliated hospital. Patients 480 patients with risk factors for PONV. Interventions Patients were randomized to three groups to receive an antiemetic prophylactic combination of haloperidol and tropisetron (Group HT), dimenhydrinate and dexamethasone (Group DD), or no prophylaxis (Group P). Anesthesia was maintained with volatile anesthesia (desflurane or sevoflurane) and fentanyl or total intravenous anesthesia (TIVA). Measurements Incidence of nausea, emesis, or both in the early (0 - 2 hrs) and late (2 - 24 hrs) postoperative periods were recorded, as were the number of episodes and the time of each occurrence; and patient assessment of the PONV experience on a scale comparable to a numeric rating scale (NRS). Main Results Both antiemetic combinations significantly reduced PONV incidence. In patients who received no prophylaxis, PONV incidence was 48.2% in patients given volatile anesthetics and 43.8% in those who received TIVA. PONV incidence was 17.5% in the Group HT patients who received volatile anesthetics, and 25% in the Group HT patients who received TIVA. PONV incidence was 11.4% in Group DD patients given volatile anesthetics, and 15% in Group DD patients receiving TIVA. TIVA reduced the incidence of PONV in the early postoperative period (0-2 hrs), but increased PONV incidence in the late period (2-24 hrs). Patients given TIVA with propofol and remifentanil intraoperatively required more opioids postoperatively than patients given volatile anesthetics. Conclusion The frequency of PONV was reduced significantly with both antiemetic combinations.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2011.01.005