Breast Augmentation: Minimizing Postoperative Nausea and Vomiting (PONV), Maximizing Patient Satisfaction

摘要

Introduction: This study evaluates postoperative nausea and vomiting (PONV) after bilateral submuscular saline breast augmentation surgery. The efficacy of a particular protocol of medications and anesthetics, used during the preoperative, intraoperative, and postoperative phases of care, is evaluated.Materials and Methods: Preoperatively, all but 2 patients (who were allergic to sulfa) received 200 mg of Celebrex capsule, a cyclooxygenase (C0X)-2 inhibitor, along with Alka Seltzer Gold or Bicitra, and had the option of taking 5 mg of Valium. Six patients with a prior history of nausea and vomiting were given Emend 40 mg PO within 3 hours of surgery, and Benadryl was withheld from these 6 patients to evaluate the effects of Emend. All patients received intravenous propofol, Versed, and fentanyl for induction. Intraoperatively, they were given intravenous Zofran 4 mg, Benadryl 25 mg, and Decadron 8mg. Sevofluorane gas was used, and no nitrous gas was used. Postoperatively, patients were advised to take Celebrex. They were given supplemental prescriptions for Zofran ODT 4 mg and Valium 5 mg. Patients were advised that they could use antacids like Rolaids or Turns for postoperative nausea if needed. The questionnaire evaluated PONV on the day of surgery and on the following 2 days; patient satisfaction with the overall surgical experience was evaluated, and results of their operation were reported on a scale from 0 to 10.Results: In all, 72.6% of the 241 patients reported no nausea and vomiting on the day of surgery. The numbers of patients who reported no nausea and vomiting on the first and second days after surgery were similar, at 73% and75.5%, respectively. On average, the remaining 27.4% had some PONV ("3" on the 0 to 10 scale) on all 3 days. A total of 94% of patients reported a "10" to rate their overall experience, and 90% gave a "10" rating for the results of their operation.Conclusions: My approach, which evolved over 10 years with 3000 patients, has improved my results from several days of extremepostoperative nausea and vomiting to almost zero. I attribute much of this success to the use of Decadron, Zofran, Benadryl, and Emend, all of which may affect multiple pathways and nausea receptor sites. During surgery, I use a laryngeal mask airway (LMA) and eliminate nitrous; I believe this may help decrease postoperative nausea and vomiting. I also use Celebrex, which may possibly lower the amount of narcotic needed during and after surgery. Finally, I believe that the outstanding level of patient satisfaction reported in the study is directly related to the fact that patients had minimal or no nausea and vomiting after surgery.