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POSTOPERATIVE NAUSEA

A new study just released looks at a problem that affects millions of people going for surgery each year—postoperative nausea and vomiting. This research tested a variety of different regimens, altering the combinations of anesthetics, pain medicines, and anti-nausea drugs. It found that a drug that costs next to nothing is the best first treatment at preventing this awful condition.

Betty Olt would have taken anything the first time she woke up from surgery. She was sick for a full 24 hours starting as soon as she woke up after surgery. “Visitors were holding a tray for me. I slept an hour, then I’d get up and throw up, it was awful,” recalls Betty.
Anesthesia is given to 75 million surgical patients around the world each year. A third of them will report postoperative nausea, vomiting or both. And many report postoperative nausea and vomiting worse than postoperative pain.
Dr. Peter Walker, Chief of Anesthesiology at Long Island Jewish Medical Center in New York, says, “The risk is there for everyone, it’s higher if you’re a woman if you’re having pelvic surgery or intra-abdominal body cavity surgery, or if you’re having other medications that may trigger nausea and vomiting.”
The new research in the latest New England Journal of Medicine, looked at whether individual drugs or a drug cocktail would be the most effective way to control postoperative nausea and vomiting. It showed each of these anti-nausea drugs individually reduced the risk of postoperative nausea and vomiting by 26%. On the more expensive end is Zofran, given at the end of surgery. The researchers say it should be used in case of nausea and vomiting that is not controlled. Decadron, which costs just 58 cents per dose, is highly effective when given at the beginning of the procedure, especially for women having gynecological surgery. “The study seems to recommend that for the cost benefit ratio, it may be the best single drug, if you are going to use one drug,” says Dr. Walker.
In fact, the researchers believe that Decadron should probably be used first along with an injected anesthetic, Propofol, rather than an inhaled anesthetic, because Propofol was shown in the study to lower the risk of nausea and vomiting. Still, Dr. Walker says there is no one set recipe for all individuals. “With every patient in every circumstance obviously the best thing is to tailor the medication to that patient’s specific needs,” he says.
The study shows a diminished return with each drug added, making it probably not worth it to give more medications at first. Dr. Walker says that as safe as the medications are, you have to consider that all drugs have some risk profile, so you shouldn’t just pour every possible anti-nausea drug into a patient to prevent nausea and vomiting.
As for Betty, she had another surgery two weeks later, and the story turned out much better. “They must have added other agents because I wasn’t sick the second time.”

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