Control Of Nausea Research Articles

Control of Postoperative Nausea and Vomiting in Oral and Maxillofacial Surgery Patients with Isopropyl Alcohol: A Prospective Randomized Clinical Trial.

The present study was undertaken to evaluate the effectiveness of inhaled 70% isopropyl alcohol (IPA) in controlling postoperative nausea and vomiting (PONV) in oral and maxillofacial surgery patients undergoing surgery under general anesthesia (GA). This was a prospective, randomized, case-controlled study done on 208 maxillofacial surgery patients operated under GA. Patient's demographic data, APFEL score for risk of PONV, duration of surgery and duration of anesthesia were recorded preoperatively. The test arm of the study received inhalation of 70% IPA every half an hour in the postoperative period for 8h along with ondansetron 4mg i.v. every 6h. The control arm received only ondansetron 4mg i.v. every 6h. Both the groups followed the same preoperative and postoperative instruction and drug protocol except the test drug. PONV was recorded using the simplified PONV intensity score and VAS. The scores were analyzed with Mann-Whitney test with <0.05 considered significant. The groups were similar with regard to age (p=0.083), BMI (p=0.1.00), sex (p=0.379), type of surgery (p=0.504), duration of anesthesia (p=0.621), duration of surgery (p=0.515) and APFEL score (p=0.687). IPA inhalation group achieved significantly better simplified PONV scores and VAS scores at 4h (p=0.000), 6h (p=0.000) and 8h (p=0.000). PONV control at 2h was similar to the control group. Inhalation of 70% IPA every half an hour was associated with significant PONV control in maxillofacial surgery patients undergoing surgery under GA.

Control of Nausea and Vomiting in Patients Receiving Anthracycline/Cyclophosphamide Chemotherapy for Breast Cancer.

Chemotherapy-induced nausea and vomiting (CINV) is one of most distressing adverse events during cancer chemotherapy. In breast cancer patients receiving anthracycline and cyclophosphamide (AC) chemotherapy, CINV is poorly controlled. The prevalence of guideline-consistent antiemetic medication and control of CINV were investigated retrospectively in breast cancer patients receiving the first cycle of AC chemotherapy. Risks for CINV were analyzed by the multivariate logistic regression analysis. The effect of olanzapine added to the standard antiemetic medication on the incidence of CINV was subsequently evaluated in separate patients who received the first cycle of AC chemotherapy. Although the guideline-consistent antiemetic medication was performed in all subjects, the control rate of nausea (32%), but not vomiting (78%) was low. Risk analysis indicated that age younger than 55-year-old was a significant factor that reduces the control of both nausea and vomiting. Olanzapine (5 mg/day for 5 days), when added to the standard three-drug antiemetic medication, significantly improved the control of nausea and complete response. CINV was poorly controlled in breast cancer patients receiving AC chemotherapy, in which age younger than 55-year-old was a significant risk for both nausea and vomiting. Olanzapine was effective for improvement of the control of CINV associated with AC chemotherapy. Therefore, care should be taken to prevent CINV in young patients receiving AC chemotherapy by adding olanzapine to the standard three-drug antiemetic medication.

Olanzapine-Based Triple Regimens Versus Neurokinin-1 Receptor Antagonist-Based Triple Regimens in Preventing Chemotherapy-Induced Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy: A Network Meta-Analysis.

The current antiemetic prophylaxis for patients treated with highly emetogenic chemotherapy (HEC) included the olanzapine-based triplet and neurokinin-1 receptor antagonists (NK-1RAs)-based triplet. However, which one shows better antiemetic effect remained unclear. We systematically reviewed 43 trials, involving 16,609 patients with HEC, which compared the following antiemetics at therapeutic dose range for the treatment of chemotherapy-induced nausea and vomiting: olanzapine, aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant. The main outcomes were the proportion of patients who achieved no nausea, complete response (CR), and drug-related adverse events. A Bayesian network meta-analysis was performed. Olanzapine-based triple regimens showed significantly better no-nausea rate in overall phase and delayed phase than aprepitant-based triplet (odds ratios 3.18, 3.00, respectively), casopitant-based triplet (3.78, 4.12, respectively), fosaprepitant-based triplet (3.08, 4.10, respectively), rolapitant-based triplet (3.45, 3.20, respectively), and conventional duplex regimens (4.66, 4.38, respectively). CRs of olanzapine-based triplet were roughly equal to different NK-1RAs-based triplet but better than the conventional duplet. Moreover, no significant drug-related adverse events were observed in olanzapine-based triple regimens when compared with NK-1RAs-based triple regimens and duplex regimens. Additionally, the costs of olanzapine-based regimens were obviously much lower than the NK-1RA-based regimens. Olanzapine-based triplet stood out in terms of nausea control and drug price but represented no significant difference of CRs in comparison with NK-1RAs-based triplet. Olanzapine-based triple regimens should be an optional antiemetic choice for patients with HEC, especially those suffering from delayed phase nausea. According to the results of this study, olanzapine-based triple antiemetic regimens were superior in both overall and delayed-phase nausea control when compared with various neurokinin-1 receptor antagonists-based triple regimens in patients with highly emetogenic chemotherapy (HEC). Olanzapine-based triplet was outstanding in terms of nausea control and drug price. For cancer patients with HEC, especially those suffering from delayed-phase nausea, olanzapine-based triple regimens should be an optional antiemetic choice.

Efecto de la administración de dexametasona sobre la glucosa plasmática en pacientes diabéticos bajo anestesia general balanceada en el Hospital Central Militar

Background: Dexamethasone has an important role in the control of postoperative nausea and vomiting, since it has shown great efficacy; however, its use in diabetic patients is cautious or avoided by many anesthesiologists because of the increase in plasma glucose it produces. Objective: To evaluate if there is a signifi cant increase in plasma glucose in diabetic patients after the administration of dexamethasone for prophylaxis of postoperative nausea and vomiting in balanced anesthesia. Material and methods: Diabetic patients from the Hospital Central Militar undergoing surgery under balanced general anesthesia, divided into group 1 (dexamethasone) and group 2 (no dexamethasone). We measured baseline blood glucose, and two and 24 hours after the administration of dexamethasone or initiation of the anesthetic procedure; we applied a questionnaire on whether or not they had nausea, vomiting and pain assessment. Results: Dexamethasone improved outcomes in postoperative pain, nausea and vomiting prevention; a greater increase in plasma glucose was observed in those who used dexamethasone, but in all of them, it was statistically non-signifi cant. Conclusion: We observed in the study that the use of dexamethasone increased plasma glucose in comparison with those patients in whom it was not used; however, it was not statistically signifi cant, and during the study, we observed no difference in the evolution of the patients that might suggest its use was harmful, so it can be recommended as an adjuvant for the prophylaxis of postoperative nausea and vomiting.

Acupressure bands do not improve chemotherapy-induced nausea control in pediatric patients receiving highly emetogenic chemotherapy: A single-blinded, randomized controlled trial.

Chemotherapy-induced nausea and vomiting remain common, distressing side effects of chemotherapy. It has been reported that acupressure prevents chemotherapy-induced nausea in adults, but it has not been well studied in children. In this multicenter, prospective, randomized, single-blind, sham-controlled trial, the authors compared acute-phase nausea severity in patients ages 4 to 18 years who were receiving highly emetic chemotherapy using standard antiemetic agents combined with acupressure wrist bands, the most common type of acupressure, versus sham bands. Patients wore acupressure or sham bands continuously on each day of chemotherapy and for up to 7 days afterward. Chemotherapy-induced nausea severity in the delayed phase and chemotherapy-induced vomiting control in the acute and delayed phases also were compared. Of the 187 patients randomized, 165 contributed nausea severity assessments during the acute phase. Acupressure bands did not reduce the severity of chemotherapy-induced nausea in the acute phase (odds ratio [OR], 1.33; 95% confidence limits, 0.89-2.00, in which an OR <1.00 favored acupressure) or in the delayed phase (OR, 1.23; 95% CL, 0.75-2.01). Furthermore, acupressure bands did not improve daily vomiting control during the acute phase (OR, 1.57; 95% CL, 0.95-2.59) or the delayed phase (OR, 0.84; 95% CL, 0.45-1.58). No serious adverse events were reported. Acupressure bands were safe but did not improve chemotherapy-induced nausea or vomiting in pediatric patients who were receiving highly emetic chemotherapy. Cancer 2018;124:1188-96. © 2017 American Cancer Society.

Control of Nausea Based on Risk Analysis in Patients with Esophageal and Gastric Cancer Who Received Cisplatin-based Chemotherapy.

Cisplatin is commonly used for esophageal and gastric cancer, but has a high emetic risk. Although the control of vomiting is favorable, nausea is still poorly controlled in patients receiving cisplatin-based regimens. The present study was designed to determine the risks for cisplatin-induced nausea. The effect of olanzapine, an antipsychotic drug, as an antiemetic for patients with risk of poor control of nausea was subsequently examined. The prevalence of antiemetic medication and the control of nausea and vomiting were retrospectively examined in patients with esophageal or gastric cancer receiving the first cycle of cisplatin-based chemotherapy. Risks for nausea were analyzed by multivariate logistic regression analysis, in which threshold for age and cisplatin dose wer assessed by receiver operating characteristic curve analysis. A total of 186 patients received cisplatin-based regimens during January 2011 and December 2016. Guideline-consistent antiemetic medication was administered to all patients. Although the rate of no vomiting was high (93%), the rate of non-significant (grade 2 or more) nausea was insufficient (64%) during the overall period. Risk analysis showed that cisplatin dose of 50 mg/m2 or more and female gender were significant risks for nausea. Addition of olanzapine, but not of prochlorperazine, to the standard antiemetic medication was effective in suppressing nausea in patients who experienced nausea in the first cycle. Being female and cisplatin doses at 50 mg/m2 or more were demonstrated to increase risk for nausea. Addition of olanzapine to the standard medication was effective in preventing nausea in high-risk patients with esophageal and gastric cancer.

Effect of intra-operative single dose of dexamethasone for control of post-operative nausea and vomiting on the control of glucose levels in diabetic patients

BackgroundDexamethasone adds a unique challenge to glycemic control, and it may complicate patient care if there is an association between intra-operative dexamethasone and blood glucose levels. MethodsWe analyzed 396 diabetic patients who underwent general anesthesia for various surgical procedures and were hospitalized post-operatively for at least 24 h between January 2015 and June 2016. Patients were classified into two groups-those who received dexamethasone intra-operatively and those who did not. The groups were analyzed for blood glucose changes during and following their procedure. ResultsA total of 396 diabetic patients (152 (38.8%) dexamethasone group; 244 (62.2%) control) were included. The dexamethasone group had significantly lower preoperative blood glucose (135.5 mmol/L) compared to the control group (144.4 mmol/L) (p = 0.04) and significantly lower proportion of patients who had received insulin during surgery (14.9%) compared to the control group (23.4%) (p = 0.04). Overall, glucose levels declined from pre-op to post-op day 1 by 9.6 (62.9) (p = 0.007). ConclusionDiabetic patients receiving dexamethasone for control of post-operative nausea during surgery are at greater risk for increasing blood glucose levels and difficult glycemic control during and after surgery compared to patients receiving other medications to control post-operative nausea.

CHEMOTHERAPY REGIMEN AC (DOXORUBICIN AND CYCLOPHOSPHAMIDE) IN BREAST CANCER – PREVENTION OF NAUSEA AND VOMITING

Chemotherapy regimen AС (doxorubicin and cyclophosphamide) is the most often used in adjuvant chemotherapy of breast cancer. AC regimen is high emetogenic. Objective – to evaluate the effectiveness of the combination of aprepitant, ondansetron and dexamethasone for the prevention of nausea and vomiting in patients with breast cancer receiving chemotherapy regimen AC. Materials and methods : 82 female patients with breast cancer received adjuvant chemotherapy regimen AC: doxorubicin 60 mg/ m 2 , cyclophosphamide 600 mg/m 2 in day 1, each 21 day 4 cycle. Patients received an triple-therapy regimen (aprepitant 125 mg p.o. in day 1, 80 mg in days 2 and 3, ondansetron 8 mg i.v. in 1 day, dexamethasone 12 mg i.v.in 1 day, then to 8 mg/day p.o. in days 2–4) for prevention of nausea and vomiting. Results : During the first cycle of chemotherapy in acute phase (0-24 hours from the start of chemotherapy) complete control of nausea and vomiting was achieved at 72 (87.8%) patients. During delayed phase (25-120 hours from the start of chemotherapy) complete control achieved at 56 (68.3%)patients . 57.3% of patients had complete control of nausea and vomiting during all 4 cycles. Conclusion: Adequate regimen for prevention of nausea and vomiting is combination of NK1 receptor antagonist, 5-HT3 receptor antagonist and dexamethasone. Triple-therapy regimen allows more than half of the patients undergo 4 cycles of AC without nausea and vomiting.

Rolapitant: An NK-1 Receptor Antagonist for the Prevention of Chemotherapy- Induced Nausea and Vomiting

Nausea and vomiting are among the most feared side effects of chemotherapy and can prevent cancer patients from completing their treatment regimens. Rolapitant is a highly selective neurokinin-1 (NK-1) receptor antagonist with very good oral activity, central nervous system penetration and a long (180-hour) plasma half-life. Unlike other available NK-1 receptor antagonists, rolapitant does not inhibit or induce cytochrome P450 (CYP) 3A4. Findings from recent phase II and III clinical trials of rolapitant in patients receiving highly or moderately emetogenic chemotherapy are reviewed and discussed. The addition of a single-dose of rolapitant to combination 5-hydroxytryptamine type 3 receptor antagonist and dexamethasone regimens provided increased protection against chemotherapyinduced nausea and vomiting, a benefit that encompassed the entire at-risk period investigated (0-120 hours after initiation of chemotherapy) in patients receiving highly or moderately emetogenic chemotherapy. Rolapitant was well tolerated by patients in these trials, with the overall frequency of treatment- related adverse events similar in patients receiving rolapitant (7.0%) and active placebo (6.3%). Rolapitant's favorable toxicity profile and lack of CYP3A4-related drug-drug interactions indicate that it would be a suitable treatment for older patients or those with multiple comorbidities, who are likely to be receiving a number of concomitant medications. Future studies should focus on the role of rolapitant in the control of chemotherapy-induced nausea and vomiting in patients receiving multiple-day chemotherapy, specific chemotherapy agents or high-dose chemotherapy and stem cell support.

P3-010 - Olanzapine administration for refractory emesis of cisplatin with radiation therapy for head and neck cancer

High dose cisplatin with radiation therapy has been the standard regimen for head and neck cancer patients, but it is one of the most emetogenic regimen. We were difficult in the control of nausea. On the other hand, olanzapine is an atypical antipsychotic agent of the thiobenzodiazepine class that has the ability to block many different receptors, which explains its antiemetic properties. Phase 3 studies revealed it was useful for CINV, but olanzapine has not yet been approved for CINV in Japan. Now we examined retrospective about the usefulness of olanzapine To assess the safety and efficacy of olanzapine for antiemetic agents refractory CINV, Japanese head and neck cancer patients with high dose cisplatin with radiation in our institute were investigated retrospectively. 14 patients with head and neck cancer were treated with high-dose cisplatin containing chemoradiation from September 2015 to August 2016. All patients were administered fosaprepitant (150 mg IV), palonosetron (0.25 mg IV) and dexamethasone (12 mg IV) according to highly emetic chemotherapy based on Japanese antiemetic guidelines 2010 ver.1.2. 12 patients were caused grade 3 CINV, and three patients were caused grade 1 or 2 CINV. Five patients of 12 patients were caused grade 3 CINV, despite the addition of additional dexamethasone and prochlorperazine. These five patients were orally administered olanzapine 5mg. After taking olanzapine, CINV of all these patients were decreased within 3 days. However four patients could stop taking olanzapine within nine days, one patient had to continue taking olanzapine 42 days because of continuing breakthrough CINV. One patient was caused somnolence by olanzapine, other patients were not received any side effects. Olanzapine is good for CINV of general antiemetic agents refractory emesis of high dose cisplatin with radiation therapy for head and neck carcinoma, and its effect appears quickly.

Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future.

Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future.

Novel therapeutics in supportive cancer treatment

With constantly improving cancer therapies, patient’s quality of life, the management of potential side effects and treatment-related symptoms have also made considerable progress. Chemotherapy-induced nausea and vomiting (CINV) still constitutes a major problem for many patients. New developments in the field allow a more comfortable administration of guideline-based antiemetic therapy and may further improve the control of nausea. Therapeutic options for the cancer anorexia–cachexia syndrome (CACS), common in advanced cancers, are still limited and hampered by numerous side effects. Among these, targeting the ghrelin-receptor pathway could be a novel approach; however, data are still immature.

The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial.

To evalute the efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty (THA). One hundred ten patients received two-dose of 10mg IV-dexamethasone (group dexa) or IV-isotonic saline (group placebo). The level of C-reactive protein (CRP) and interleukin-6 (IL-6), pain at rest and during mobilization, incidence of post-operative nausea and vomiting (PONV), intensity of nausea, post-operative fatigue, consumption of analgesic and antiemetic rescue, range of motion (ROM), post-operative length of stay (post-operative LOS), wound problems and complications were recorded and compared. The level of inflammation markers (CRP, IL-6) in group dexa was lower than group placebo at 24, 48, 72 hours post-operatively. Dynamic pain VAS score at 24 hours was lower in group dexa (P=0.002), however, there was no significant effect on pain at rest. In group dexa, patients had a lower incidence of PONV (P=0.003), as well as a lower VAS score of nausea (P=0.044). The post-operative fatigue (P<0.001) was relieved and the consumption of analgesic and antiemetic rescues were reduced. Furthermore, patients had better maximum hip flexion (P<0.001) and abduction (P=0.017), with shorter post-operative LOS (P=0.006). There is no difference between groups in wound problems. No surgical site infection or gastrointestinal haemorrhage was detected in both groups. The administration of two low-dose peri-operative dexamethasone can effectively reduce the post-operative level of CRP and IL-6, provide additional pain and nausea control, ameliorate post-operative fatigue, enhance mobility, and shorten post-operative LOS following THA, without increasing the risk of infection and gastrointestinal hemorrhage. I.

Nausea and vomiting in children and adolescents receiving intrathecal methotrexate: A prospective, observational study.

The prevalence of nausea and vomiting after receipt of intrathecal methotrexate (IT-MTX) in pediatric oncology patients is unknown. Patients (4-18 years) about to receive IT-MTX were eligible to participate in this prospective, observational study. Patients received antiemetics as prescribed by their clinical team. Nausea severity (patient-assessed), timing of emetic episodes, and administration of antiemetics were recorded beginning immediately prior to IT-MTX administration, for the next 24 hr (acute phase), and for a maximum of 7 additional days (delayed phase). Complete chemotherapy-induced nausea and vomiting (CINV) control was defined as no emetic episodes and no nausea. One hundred patients consented to participate in this study; 70 provided evaluable data (mean age: 8.3 years; range: 4.1-17.6). Most (94%) received propofol-containing anesthesia for IT-MTX administration. Most (89%) received a 5-HT3 antagonist prior to IT-MTX. During the acute phase, 36 children (51%) experienced complete CINV control, 67 (96%) complete vomiting control, and 36 (51%) complete nausea control. Severe acute phase nausea was reported by 12 children (17%). During the delayed phase, 35 patients (50%) experienced complete CINV control, 60 (86%) complete vomiting control, and 36 (51%) complete nausea control. Severe nausea was reported in the delayed phase by 27 (39%) patients. Most pediatric patients who received IT-MTX and prophylaxis with ondansetron or granisetron experienced complete acute and delayed vomiting control. However, nausea control was poor and severe nausea was reported by many children. Effective interventions to control nausea are needed.

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

The prevention of chemotherapy‐induced nausea and vomiting was one of the most challenging supportive care issues in oncology, especially to highly emetogenic chemotherapy (HEC). A total of 645 patients were randomized into fosaprepitant group (fosaprepitant/placebo 150 mg d1 in combination with granisetron and dexamethasone) or aprepitant group (aprepitant/placebo 125 mg d1; 80 mg d2‐d3 plus granisetron and dexamethasone).The primary endpoint was the percentage of patients who had a complete response (CR) over the entire treatment course (0–120 hr, overall phase [OP]). It was assessed by using a non‐inferiority model, with a non‐inferiority margin of 10%. The difference of the CR rate was compared between two groups with chi‐square analysis. Six hundred and twenty‐six patients were included in the per protocol analysis. The percentage of patients with a CR in the fosaprepitant group was not inferior to that in the aprepitant group (90.85% versus 94.17%, p = .1302) during OP. Whether the cisplatin‐based chemotherapy or not, the CR rate of the fosaprepitant group was not inferior to that of the aprepitant group. Both regimens were well tolerated. The most common adverse event was constipation. Fosaprepitant provided effective and well‐tolerated control of nausea and vomiting associated with HEC in Chinese patients.

P18.02 Prospective evaluation of quality of life in patients with recurrent high grade glioma treated with re-irradiation by tomotherapy based IMRT

Abstract Introduction: Prospective quality of life (QOL) evaluation in re-irradiation (reRT) for recurrent high grade glioma (HGG) is rare but an important endpoint. We report a prospective study of patient reported QOL and activities of daily living (ADL) as primary end point in patients treated with re-irradiation (reRT) for recurrent HGG. Materials and Methods: 34 patients of recurrent HGG with Karnofsky Performance Status (KPS) ≥60 planned for re-irradiation as per joint neuro-oncology meeting decision were included. Image guided intensity modulated radiotherapy (IG-IMRT) was delivered with helical tomotherapy at 1.8 Gy/fraction to 45-55 Gy. Serial QOL and ADL evaluation was done by a trained occupational therapist using validated Indian translations of EORTC QLQ30 + BN20 and Barthel’s ADL Index, before starting reRT and at 1,3,6,9 and 12 months follow up post reRT. Results: At recurrence, 56% HGG were grade 3 and 44% were grade 4 tumours. 65% patients had HGG transformed from a previous low grade glioma. Before reRT, 74% patients had undergone re-surgery and 59% had received salvage chemotherapy with either temozolomide or bevacizumab. Median interval from primary RT was 6.7 years. Planned reRT dose was completed by 91% patients, with 27% requiring treatment interruption. Concurrent chemotherapy was planned for 77% patients, of which 27% required early cessation due to poor tolerance. Concurrent corticosteroid support was required by 41% patients. QOL questionnaires were completed by patients themselves in 85% instances while 15% were filled in proxy by primary caregivers. Mean baseline global QOL score was 61/100, which remained stable up to 50.5/100 at 6 months post reRT. Global QOL was stable in 15/25 patients at 1 month, 13/20 at 3 months, 7/16 at 6 months and 4/10 patients at 1 year post RT. Mean physical and social function scores were stable till 6 months. Emotional, role and cognitive function scores remained stable till 9 months. Mean baseline ADL score was 16.5/20, declining to 14/20 at 9 months post reRT. Among symptom scores, appetite loss and seizures remained stable till 3 months while scores for fatigue, insomnia and weakness of legs were stable till 6 months. Scores for motor dysfunction, communication deficit, nausea and bladder control remained stable till 9 months. Remaining symptom scores showed no significant decline till 1 year post RT. Pseudo progression was seen in 9/34 patients. At the time of analysis, 17/34 patients are alive and on follow-up. Decline in QOL scores at 6 to 9 months coincided with a median progression free survival of 36.5 weeks. Median overall survival was 46.5 weeks. Serial QOL and ADL scores did not correlate significantly with age, sex, KPS, tumour location and grade. CONCLUSION: Clinical experience of re-irradiation in recurrent HGG with IG-IMRT has been encouraging in terms of tolerance and palliation, providing reasonably stable QOL till tumour progression.

Prophylaxis of radiation-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials.

The aim of this article was to systematically review the efficacy and safety of various antiemetics in prophylaxis of radiation-induced nausea and vomiting (RINV). A literature search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy of prophylaxis for RINV in patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). Primary endpoints were complete control of nausea and complete control of vomiting during acute and delayed phases. Secondary endpoints included use of rescue medication, quality of life (QoL) and incidence of adverse events. Seventeen RCTs were identified. Among patients receiving radiotherapy to abdomen/pelvis, our meta-analysis showed that prophylaxis with a 5-hydroxytryptamine-3 receptor antagonist (5HT3 RA) was significantly more efficacious than placebo and dopamine receptor antagonists in both complete control of vomiting [OR 0.49; 95% confidence interval (CI): 0.33-0.72 and OR 0.17; 95% CI: 0.05-0.58 respectively] and complete control of nausea (OR 0.43; 95% CI: 0.26-0.70 and OR 0.46; 95% CI: 0.24-0.88 respectively). 5HT3 RAs were also more efficacious than rescue therapy and dopamine receptor antagonists plus dexamethasone. The addition of dexamethasone to 5HT3 RA compared to 5HT3 RA alone provides a modest improvement in prophylaxis of RINV. Among patients receiving TBI, 5HT3 RA was more effective than other agents (placebo, combination of metoclopramide, dexamethasone and lorazepam). 5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiotherapy to abdomen/pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as substance P neurokinin 1 receptor antagonists in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases.

The association between frequent alcohol drinking and opioid consumption after abdominal surgery: A retrospective analysis.

AimsIt is perceived that patients with a history of frequent alcohol consumption require more opioids for postoperative pain control and experience less postoperative nausea and vomiting than patients without such a history. However, there is scarce evidence supporting this notion. The aim of this study was to assess association between frequent alcohol consumption and opioid requirement for postoperative pain control and occurrence of postoperative nausea and vomiting.MethodsThe medical records for 4143 patients using intravenous patient-control analgesia with opioids after abdominal surgery between January 2010 and September 2013 were obtained, and associations were sought between the cumulative opioid consumption (in intravenous morphine equivalence) per body weight (mg/kg) in the first 2 days after abdominal operation and several demographic and clinical variables by multiple regression analysis. The association between the occurrence of postoperative nausea and vomiting and several demographic and clinical variables was also sought by multiple logistic regression analysis.ResultsFrequent alcohol drinking, among other previously reported factors, was associated with increased opioid consumption for postoperative pain control (p < 0.001). The estimate effect of frequent alcohol drinking was 0.117 mg/kg. Frequent alcohol drinking was also associated with decreased risks of postoperative nausea (odds ratio = 0.59, p = 0.003) and vomiting (odds ratio = 0.49, p = 0.026).ConclusionsFrequent alcohol drinking was associated with increased opioid consumption for postoperative pain control and decreased risks of postoperative nausea and vomiting after abdominal surgery.

Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment: A Systematic Review of Literature.

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.

Systematic review of safeness and therapeutic efficacy of cannabis in patients with multiple sclerosis, neuropathic pain, and in oncological patients treated with chemotherapy

medical cannabis refers to the use of cannabis or cannabinoids as medical therapy to treat disease or alleviate symptoms. In the United States, 23 states and Washington DC (May 2015) have introduced laws to permit the medical use of cannabis. Within the European Union, medicinal cannabis laws and praxis vary wildly between Countries. to provide evidence for benefits and harms of cannabis (including extracts and tinctures) treatment for adults in the following indications: control of spasticity and pain in patients with multiple sclerosis; control of pain in patients with chronic neuropathic pain; control of nausea and vomiting in adults with cancer receiving chemotherapy. we searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE from inception to September 2016. We also searched for on-going studies via ClinicalTrials.gov and the World Health Organization and International Clinical Trials Registry Platform (ICTRP) search portal. All searches included also non-English language literature. All relevant randomized controlled trials (RCTs) evaluating the safety and efficacy of cannabis (including extracts and tinctures) compared with placebo or other pharmacological agents were included. Three authors independently evaluated the titles and abstracts of studies identified in the literature searches for their eligibility. For studies considered eligible, we retrieved full texts. Three investigators independently extracted data. For the assessment of the quality of evidence, we used the standard methodological procedures recommended by Cochrane and GRADE working Group. 41 trials (4,550 participants) were included; 15 studies considered efficacy and safety of cannabis for patients with multiple sclerosis, 12 for patients with chronic pain, and 14 for patients with cancer receiving chemotherapy. The included studies were published between 1975 and 2015, and the majority of them were conducted in Europe. We judged almost 50% of these studies to be at low risk of bias. The large majority (80%) of the comparisons were with placebo; only 8 studies included patients with cancer receiving chemotherapy comparing cannabis with other antiemetic drugs. Concerning the efficacy of cannabis (compared with placebo) in patients with multiple sclerosis, confidence in the estimate was high in favour of cannabis for spasticity (numerical rating scale and visual analogue scale, but not the Ashworth scale) and pain. For chronic and neuropathic pain (compared with placebo), there was evidence of a small effect; however, confidence in the estimate is low and these results could not be considered conclusive. There is uncertainty whether cannabis, including extracts and tinctures, compared with placebo or other antiemetic drugs reduces nausea and vomiting in patients with cancer requiring chemotherapy, although the confidence in the estimate of the effect was low or very low. In the included studies, many adverse events were reported and none of the studies assessed the development of abuse or dependence. there is incomplete evidence of the efficacy and safety of medical use of cannabis in the clinical contexts considered in this review. Furthermore, for many of the outcomes considered, the confidence in the estimate of the effect was again low or very low. To give conclusive answers to the efficacy and safety of cannabis used for medical purposes in the clinical contexts considered, further studies are needed, with higher quality, larger sample sizes, and possibly using the same diagnostic tools for evaluating outcomes of interest.