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Treatments curb nausea after surgery
Last Updated: 2004-06-09 17:00:07 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In a new study, several strategies were comparable in preventing the nausea and vomiting that can occur after surgery. This implies that safety and cost should be the main reasons for choosing a particular preventive treatment.
The findings are based on a study of over 4000 surgery patients who were randomly assigned to 1 of 64 possible combinations of six different approaches to preventing anti-nausea treatment.
These interventions included administration of the antiemetic agents odansetron, dexamethasone or droperidol or not, and the use of various anesthetic agents -- a volatile anesthetic or propofol, nitrogen or nitrous oxide, and remifentanil or fentanyl.
Dr. Christian C. Apfel, from the University of Louisville in Kentucky, and colleagues report their findings in this week's issue of The New England Journal of Medicine.
Overall, the rate of nausea and vomiting in untreated patients was 52 percent, the authors report. The rates when one, two, or three interventions were employed were 37 percent, 28 percent, and 22 percent, respectively.
Treatment with ondansetron, dexamethasone, or droperidol reduced the risk of nausea and vomiting by about 26 percent. The combination of propofol and nitrogen produced a comparable reduction in risk.
In a related editorial, Dr. Paul F. White, from the University of Texas Southwestern Medical Center in Dallas, draws several conclusions from the study.
"First, the efficacy of prophylactic antiemetic drug therapy is dependent on the patient's overall risk of postoperative nausea and vomiting," he states.
Also, using two inexpensive anti-nausea drugs, like droperidol and dexamethasone, offers a much greater benefit than using one expensive agent, such as odansetron.
Furthermore, there are diminishing returns with each successive intervention that is added.
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