Prevention of nausea and vomiting following breast surgery.
BACKGROUND
The purpose of this study was to determine the rate of nausea and vomiting in women following breast surgery (PONV) under general anesthesia (GA), before and after the introduction of a standardized prophylactic anti-emetic (AE) regimen.


METHODS
We performed a retrospective review of eligible patients, between July 2001 and March 2003. Patients operated on before September 2002 had standard preoperative care (old cohort [OC]); patients operated on after September 2002 were treated prophylactically with oral dronabinol 5 mg and rectal prochlorperazine 25 mg (new cohort [NC]). Data were collected from hospital records regarding age, diagnosis, comorbid conditions, previous anesthesia history, anesthesia and operative details, episodes PONV, and use of AE. The rate and severity of PONV was calculated for both cohorts.


RESULTS
Two hundred forty-two patients were studied: 127 patients in the OC and 115 patients in the NC. The median age was 56 years (range 32 to 65). The rate of nausea and vomiting were significantly better in the patients treated prophylactically with dronabinol and prochlorperazine (59% vs. 15%, P < .0001 and 29% vs. 3%, P < .0001). Twenty patients in the OC were given some prophylactic AE treatment and 12 (60%) of them required further treatment; only 12 of 109 patients (11%) in the NC required further AE treatment (P < .0001).


CONCLUSIONS
PONV is a significant problem in breast surgical patients. Preoperative treatment with dronabinol and prochlorperazine significantly reduced the number and severity of episodes of PONV.
Layeeque
Rakhshanda
R
Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences and The Central Arkansas Veterans Hospital System, 4301 W. Markham, Slot 725, Little Rock, AR 72205, USA.
Siegel
Eric
E
Kass
Rena
R
Henry-Tillman
Ronda S
RS
Colvert
Maureen
M
Mancino
Anne
A
Klimberg
V Suzanne
VS
D000284:Administration, Oral; D000285:Administration, Rectal; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D013759:Dronabinol / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011322:Primary Prevention; D011336:Probability; D011346:Prochlorperazine / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D000932:Antiemetics; D013759:Dronabinol; D011346:Prochlorperazine