[Multimodal treatment of pain and nausea in breast cancer surgery]

Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV associated with surgery for these patients.

116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime consisting of Paracetamol, Celecoxib, Dextromethorphan, Gabapetin, Dexamethason and Ondansetron.

In the recovery room, 75% of the patients scored either no or light pain at rest compared to 68% under mobilization. In the department, 94% of the patients scored no or light pain at rest as well as under mobilization on the evening of the operation and the next morning. Morphine consumption in the recovery room was, on average, 2 mg per patient. Only 1.5% of the patients were given morphine in the department. Five patients were troubled by light PONV, one by moderate PONV and another suffered from severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later.

It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain optimal postoperative pain and nausea control without significant problems with respect to sedation.