Improving Postoperative Nausea and Vomiting
Postoperative nausea and vomiting (PONV) is still the most common side effect experienced by plastic surgery patients despite advances in modern medicine. While studies have been conducted to find ways of improving PONV, there is not yet a definitive cure.
The unpleasant symptoms are often delayed until the patient gets home, and unfortunately, the effects of PONV go beyond pain and discomfort. The uncontrollable vomiting puts the patient at risk of opening up sutures, which could result in a longer recovery, infection or additional hospitalization.
The study “Pain as a Factor Complicating Recovery and Discharge After Ambulatory Surgery,” conducted by D. Janet Pavlin, MD, was published in the 2002 peer-reviewed journal, Anesthesia and Analgesia. It was the first study to reveal that 72 percent of all plastic surgery patients suffer from PONV prior to surgery.
This shocked leading surgeons and plagued the field of plastic surgery. At the time, the leading innovator of anethesia, Barry L. Friedberg, MD, publically announced his displeasure for the results. He attributed the high PONV rate to the fact that Anesthesiologists were not looking for new anesthesia techniques that would reduce PONV, but were instead settling for the archaic clinical practices.
This study sparked dialogue among surgeons and Anesthesiologists and was the beginning of the search for medical advances to improve PONV. There have been a variety of studies conducted, testing various forms and combinations of medicine to see which ones are the most successful at reducing the uncomfortable and serious side affect.
Manuel C Vallejo, MD is spearheading the most recent study to determine if a specific drug combination, aprepitant plus ondansetron, will help improve postoperative nausea and vomiting in plastic surgery patients. Vallejo hypothesized that this combination will be more effective than ondansetron plus placebo in battling the symptoms during the first 48 hours prior to surgery.
Backed by the University of Pittsburg, Vallejo plans to begin the study this month. The study calls for approximately 150 subjects, both male and female, between the ages of 18 and 65. Each subject will undergo some form of facial, breast and body contouring surgical procedure. The study requires all procedures be at least one hour and the surgeon will use the same general anesthesia.
Half of the participants will be given aprepitant and ondansetron while the other half will be given ondansetron plus placebo to see which proves to be more effective in improving nausea and vomiting after each procedure. The study is expected to be completed in February 2009. Participants of the study hope this will bring the field of plastic surgery one step closer to creating a cure for PONV.
