title: Prophylaxis of postoperative nausea and vomiting in elective breast surgery.
abstract: OBJECTIVE
  To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery.
  
  
  METHODS
  Prospective, randomized, double-blinded, placebo-controlled trial.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  480 patients with risk factors for PONV.
  
  
  METHODS
  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).
  
  
  METHODS
  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).
  
  
  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.
  
  
  CONCLUSIONS
  The frequency of PONV was reduced significantly with both antiemetic combinations.
authors.affiliation: Praxis of Plastic und Aesthetic Surgery, D-79098 Freiburg, Germany. voigt-m-fr@t-online.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Voigt
authors.forename: Christian W
authors.initials: CW
authors.lastname: Fröhlich
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Waschke
authors.forename: Christian
authors.initials: C
authors.lastname: Lenz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Göbel
authors.forename: Heinz
authors.initials: H
authors.lastname: Kerger
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use*; D001940:Breast / Q000601:surgery*; D003907:Dexamethasone / Q000627:therapeutic use; D004111:Dimenhydrinate / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D011229:Preanesthetic Medication; D011446:Prospective Studies; D012307:Risk Factors; D000077526:Tropisetron
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000932:Antiemetics; D007211:Indoles; D000077526:Tropisetron; D003907:Dexamethasone; D006220:Haloperidol; D004111:Dimenhydrinate