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Multimodal prevention of pain, nausea and vomiting after breast cancer surgery.
Minerva Anestesiol. 2010 Oct; 76(10):805-13.MA

Abstract

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 regimen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexamethasone, total intravenous anaesthesia and intraoperative ondansetron. The patients were prospectively scored according 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 postoperative 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.

Authors+Show Affiliations

Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen University, Denmark. runegartner@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

20935616

Citation

Gärtner, R, et al. "Multimodal Prevention of Pain, Nausea and Vomiting After Breast Cancer Surgery." Minerva Anestesiologica, vol. 76, no. 10, 2010, pp. 805-13.
Gärtner R, Kroman N, Callesen T, et al. Multimodal prevention of pain, nausea and vomiting after breast cancer surgery. Minerva Anestesiol. 2010;76(10):805-13.
Gärtner, R., Kroman, N., Callesen, T., & Kehlet, H. (2010). Multimodal prevention of pain, nausea and vomiting after breast cancer surgery. Minerva Anestesiologica, 76(10), 805-13.
Gärtner R, et al. Multimodal Prevention of Pain, Nausea and Vomiting After Breast Cancer Surgery. Minerva Anestesiol. 2010;76(10):805-13. PubMed PMID: 20935616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multimodal prevention of pain, nausea and vomiting after breast cancer surgery. AU - Gärtner,R, AU - Kroman,N, AU - Callesen,T, AU - Kehlet,H, PY - 2010/10/12/entrez PY - 2010/10/12/pubmed PY - 2011/2/1/medline SP - 805 EP - 13 JF - Minerva anestesiologica JO - Minerva Anestesiol VL - 76 IS - 10 N2 - 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 regimen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexamethasone, total intravenous anaesthesia and intraoperative ondansetron. The patients were prospectively scored according 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 postoperative 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. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/20935616/Multimodal_prevention_of_pain_nausea_and_vomiting_after_breast_cancer_surgery_ L2 - http://www.minervamedica.it/index2.t?show=R02Y2010N10A0805 DB - PRIME DP - Unbound Medicine ER -