Multimodal prevention of pain, nausea and vomiting after breast cancer surgery

  • Gärtner R
  • Kroman N
  • Callesen T
 et al. 
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Background.Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal, opiate-sparing, evidence-based regimen for prevention of PONV and pain. Methods.Two hundred consecutive patients scheduled for breast cancer surgery were included. The prevention reg- imen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexam- ethasone, total intravenous anaesthesia and intraoperative ondansetron. The patients were prospectively scored accord- ing to PONV, pain during rest and mobilization and major side effects. Results.Of 200 consecutive breast cancer patients, 191 received the full package. During the first 36 postoperative hours, 79.1% reported no PONV at all and only 3.7% reported severe PONV. At rest, 69.6% reported no or light pain and 3.1% reported severe pain, with corresponding values of 59.7% and 8.9% during arm mobilization. Mean postoper- ative morphine consumption was 2.2 mg. The only significant side effect was transient dizziness. Conclusion. A multimodal, opiate-sparing regimen to prevent pain and PONV seems to be more effective than one- or two-component regimens on PONV and pain after breast cancer surgery, a result which calls for large-scale multi- center or randomized studies. (Minerva Anestesiol 2010;76:805-13) Key

Author-supplied keywords

  • Anaesthesia recovery period
  • Pain
  • Postoperative nausea and vomiting

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  • R. Gärtner

  • N. Kroman

  • T. Callesen

  • H. Kehlet

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