Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen University, Denmark.
Minerva Anestesiol. 2010 Oct;76(10):805-13.
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.
尽管有许多单一或双模态的尝试来缓解术后恶心和呕吐（PONV）和疼痛，但乳腺癌手术后的术后问题仍然是一个重大问题。因此，本探索性、产生假说的研究旨在评估一种多模式、阿片类药物节约、基于证据的方案预防 PONV 和疼痛的效果。
纳入 200 例连续拟行乳腺癌手术的患者。预防方案包括一个包含术前扑热息痛、右美沙芬、塞来昔布、加巴喷丁、地塞米松、全静脉麻醉和术中昂丹司琼的方案。患者根据 PONV、休息和活动时的疼痛以及主要副作用进行前瞻性评分。
在 200 例连续乳腺癌患者中，191 例接受了完整方案。在术后 36 小时内，79.1%的患者完全没有 PONV，只有 3.7%的患者报告严重 PONV。休息时，69.6%的患者报告无或轻度疼痛，3.1%的患者报告严重疼痛，手臂活动时分别为 59.7%和 8.9%。术后平均吗啡消耗量为 2.2 毫克。唯一显著的副作用是短暂头晕。
一种多模式、阿片类药物节约方案预防疼痛和 PONV 似乎比单一或双成分方案更有效预防乳腺癌手术后的 PONV 和疼痛，这一结果需要大规模多中心或随机研究。
