A Prospective Study of Nausea and Vomiting After Breast Cancer Surgery

Wesmiller, Susan W.; Bender, Catherine M.; Conley, Yvette P.; Bovbjerg, Dana H.; Ahrendt, Gretchen; Bonaventura, Marguerite; Sereika, Susan M.

doi:10.1016/j.jopan.2015.12.009

Cited by 35 publications

(25 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Type and duration of anesthesia, and medications used during the surgical procedures are also known be associated with PONV (Gan et al, 2014; Janicki et al, 2011). Additionally, in patients with breast cancer, preoperative psychological factors including distress increase the severity of PONV (Montgomery et al, 2010; Wesmiller et al, 2016). Certainly the use of 5-HT 3 antagonists, and more recently the neurokinin 1 receptor antagonists have improved the management of PONV, but despite progress based upon evidence from voluminous clinical trials examining the efficacy of antiemetic regimes, 25–30% of postoperative patients continue to suffer from vomiting, and to a greater extent, nausea.…”

Section: Introductionmentioning

confidence: 99%

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

Wesmiller

Sereika

Bender

et al. 2017

Autonomic Neuroscience

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Wesmiller

Sereika

Bender

et al. 2017

Autonomic Neuroscience

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, GA is considered to be related to a high incidence of postoperative nausea and vomiting (PONV), which is primarily attributed to inhalation of anesthetics, application of perioperative opioids for analgesia and susceptibility of female gender per se, thereby mitigating the patient satisfaction and delaying patient recovery after breast surgery. [ 4 – 6 ]…”

Section: Introductionmentioning

confidence: 99%

Anesthetic effect of ultrasound-guided multiple-nerve blockade in modified radical mastectomy in patients with breast cancer

Liu²,

Li³

et al. 2021

Medicine

View full text Add to dashboard Cite

Introduction: Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure. Methods: Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65 years of age and 18∼30 kg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5 ml for each intercostal nerve block, 8 ml for brachial plexus block, 7 mL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0 hour, 3 hour, 6 hour, 12 hour and 24 hour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded. Conclusions: The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.

show abstract

“…When it comes to breast surgery, a recent work reported 29% of nausea in the post-anesthesia care unit and 35% of post-discharge nausea and vomiting (PDNV) (7) in patients who received prophylactic antiemetic. In a previous study, the incidence of PONV in patients who underwent mastectomy was 38.1%, even with double antiemetic therapy (8).…”

Section: ' Introductionmentioning

confidence: 99%

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

Grigio¹,

Sousa²,

Guimarães³

et al. 2020

Clinics

View full text Add to dashboard Cite

To evaluate the addition of a fourth antiemetic intervention in patients at high risk for postoperative nausea and vomiting (PONV). METHODS: High-risk patients (Apfel score 3 or 4) scheduled for unilateral mastectomy were randomly allocated in one of two groups, oral aprepitant (oral aprepitant 80 mg, intravenous dexamethasone 8 mg, and palonosetron 0.075 mg) and oral placebo (oral placebo, intravenous dexamethasone 4 mg, and palonosetron 0.075 mg). Patients and caregivers were blinded to the group assignments. The primary efficacy endpoints included the incidence of nausea and vomiting, and the secondary endpoints included use of rescue antiemetics during a 48-hour postoperative period. ClinicalTrials.gov: NCT02431286. RESULTS: One hundred patients were enrolled in this study and 91 were analyzed, 48 in group A and 43 in group P. No patient presented with nausea or vomiting in the first 2 hours after surgery. From the 2 nd to the 6 th hour, the incidence of PONV was 8.33% in group A and 9.30% in group P. In the first 24 hours, the incidence of PONV was 27.08% in the group A and 20.93% in group P. From the 24 th to the 48 th hour, the incidence of PONV was 8.33% in group A and 13.95% in group P. There were no statistically significant differences in PONV between groups. CONCLUSION: The addition of aprepitant as a third antiemetic resulted in no significant reduction in the incidence of PONV in this population. However, the incidence of PONV was reduced in relation to the general population.

show abstract

A Prospective Study of Nausea and Vomiting After Breast Cancer Surgery

Cited by 35 publications

References 32 publications

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

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

Anesthetic effect of ultrasound-guided multiple-nerve blockade in modified radical mastectomy in patients with breast cancer

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

Contact Info

Product

Resources

About