dextromethorphan and Postoperative-Nausea-and-Vomiting

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.. 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.. 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.. 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.

Topics: Acetaminophen; Aged; Amines; Analgesics, Non-Narcotic; Anesthesia Recovery Period; Anesthesia, Intravenous; Antiemetics; Breast Neoplasms; Celecoxib; Combined Modality Therapy; Cyclohexanecarboxylic Acids; Dexamethasone; Dextromethorphan; Female; Fentanyl; Gabapentin; gamma-Aminobutyric Acid; Humans; Intraoperative Care; Lymph Node Excision; Mastectomy; Middle Aged; Morphine; Narcotics; Nervous System Diseases; Ondansetron; Pain, Postoperative; Pilot Projects; Postoperative Nausea and Vomiting; Preanesthetic Medication; Pyrazoles; Sentinel Lymph Node Biopsy; Sulfonamides

Dextromethorphan is an N-methyl-D-aspartic acid antagonist which can attenuate acute pain with few side-effects. In this prospective, randomized, double-blind study of dextromethorphan and intrathecal morphine, we investigated postoperative pain, pruritus, nausea and vomiting in women undergoing Caesarean section under spinal anaesthesia.. Women were allocated randomly to one of six groups, to receive intrathecal morphine 0.05, 0.1 or 0.2 mg plus oral dextromethorphan 60 mg or placebo.. The addition of dextromethorphan did not reduce postoperative pain scores (P=0.83). Compared with women receiving intrathecal morphine 0.05 mg, women receiving higher doses had a significantly higher incidence of nausea and vomiting [odds ratio for intrathecal morphine 0.1 mg, 4.0 (95% confidence interval 1.2-14.1); for intrathecal morphine 0.2 mg, 7.9 (2.3-27.1)]. Compared with women receiving intrathecal morphine 0.05 mg, women receiving higher doses also had a significantly higher incidence of pruritus [odds ratio for intrathecal morphine 0.1 mg, 3.2 (95% confidence interval 1.3-8.2); for intrathecal morphine 0.2 mg, 3.7 (1.4-9.5)]. Women receiving dextromethorphan had a lower incidence of nausea and vomiting [odds ratio 2.6 (1.1-6.3)].. Postoperative pain after Caesarean section under spinal anaesthesia was not reduced by the addition of oral dextromethorphan to a multimodal approach including intrathecal morphine.

Topics: Adult; Analgesia, Obstetrical; Analgesics, Opioid; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Dextromethorphan; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Female; Humans; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregnancy; Prospective Studies; Pruritus; Receptors, N-Methyl-D-Aspartate

The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure-specific evidence for prophylactic nausea, vomiting and pain treatment supported by transferable evidence from similar types of surgery. We propose a prophylactic combination of Dexametason, Ondansteron, Paracetamol, Celecoxib, Gabapentin and Detromethorphan as future treatment.

Topics: Acetaminophen; Amines; Analgesics; Antiemetics; Antitussive Agents; Breast Neoplasms; Celecoxib; Cyclohexanecarboxylic Acids; Cyclooxygenase Inhibitors; Dexamethasone; Dextromethorphan; Droperidol; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Ondansetron; Pain, Postoperative; Postoperative Nausea and Vomiting; Pyrazoles; Sulfonamides

Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV associated with surgery for these patients.. 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime consisting of Paracetamol, Celecoxib, Dextromethorphan, Gabapetin, Dexamethason and Ondansetron.. In the recovery room, 75% of the patients scored either no or light pain at rest compared to 68% under mobilization. In the department, 94% of the patients scored no or light pain at rest as well as under mobilization on the evening of the operation and the next morning. Morphine consumption in the recovery room was, on average, 2 mg per patient. Only 1.5% of the patients were given morphine in the department. Five patients were troubled by light PONV, one by moderate PONV and another suffered from severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later.. It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain optimal postoperative pain and nausea control without significant problems with respect to sedation.

Topics: Adult; Aged; Aged, 80 and over; Amines; Analgesics; Antiemetics; Antitussive Agents; Breast Neoplasms; Celecoxib; Cyclohexanecarboxylic Acids; Cyclooxygenase Inhibitors; Dexamethasone; Dextromethorphan; Droperidol; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Middle Aged; Ondansetron; Pain, Postoperative; Postoperative Nausea and Vomiting; Prospective Studies; Pyrazoles; Sulfonamides