• Journal of Korean Academy of Nursing
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• v.43 no.2
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• pp.215-224
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• 2013

Purpose: This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV). Methods: An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy. Results: The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery. Conclusion: Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.

• Korean Journal of Clinical Pharmacy
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• v.28 no.3
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• pp.224-229
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• 2018

Background: The patients receiving hematopoietic stem cell transplantation (HSCT) are known to have a high incidence of breakthrough nausea and vomiting due to the conditioning regimen. The purpose of this study was to evaluate the adequacy of antiemetic therapy for breakthrough nausea and vomiting in patients receiving HSCT and to propose an effective treatment regimen. Methods: We retrospectively reviewed the electronic medical records of 109 adult patients. The collected data were used to identify (1) antiemetic and dosing regimens prescribed for controlling breakthrough nausea and vomiting, (2) the rate of patients who developed breakthrough nausea and vomiting, and (3) the percent of antiemetics prescribed on the day of symptom onset. Based on the National Comprehensive Cancer Network guideline, we assessed the suitability of antiemetics for breakthrough nausea and vomiting, and prescription timing. Results: All patients were prescribed pro re nata antiemetics. About 40.0%, 41.4%, and 18.6% of patients were using one, two, and three or more additional drugs for breakthrough nausea and vomiting, respectively. The most frequently administered drugs were intravenous metoclopramide (43.8%) and granisetron patch (36.2%). Breakthrough nausea and vomiting occurred in 87 patients (79.1%) and they developed symptoms 320 cases. About 220 cases (68.8%) were treated with additional antiemetics on the day of symptom onset and the rate of symptom resolution was only 10.3% (9 patients). Conclusion: The breakthrough nausea and vomiting in patients receiving HSCT occurred very frequently and was hard to control, thus requiring more rapid and aggressive treatments.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.176-180
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• 2001

Background: The aim of our study was to evaluate the antiemetic effects of intravenous dexamethasone in preventing continuously infused epidural morphine-related nausea and vomiting. Methods: Twenty-seven patients requiring general anesthesia for gastrectomy were enrolled in a randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg and were connected to an epidural morphine infusion pump for 2 days in order to relieve postoperative pain. Before the morphine injection, the dexamethasone group (n = 12) received IV dexamethasone 10 mg, whereas the saline group (n = 15) received IV saline. The incidence of nausea & vomiting, pruritus, back pain and VAS scores were assessed in the recovery room, and at 24 h and 48 h postoperatively. Results: There was no significant difference in the total incidence of nausea and vomiting, pruritus, back pain or in the VAS scores. However, there was no vomiting and no back pain in the dexamethasone group. Conclusions: Intravenous dexamethasone did not significantly decrease the total incidence of nausea or vomiting in patients receiving continuous epidural morphine for postoperative pain control. However, IV dexamethasone appears to decrease the severity of nausea, vomiting and back pain.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.4125-4129
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• 2016

Background: Chemotherapy-induced nausea and vomiting (CINV) places a significant burden on the patient. Herbal agents are the most commonly complementary therapies used among the public. This study was done to determine the effect of ginger and chamomile capsules on nausea and vomiting in cases undergoing chemotherapy for breast cancer (BC). Materials and Methods: In a randomized, double-blind and clinical trial study, 65 women with BC undergoing chemotherapy were referred to Breast Cancer Research Center, Tehran, Iran, between May 2013 to June 2014. Regimen for ginger group for 5 days before and 5 days after chemotherapy was: 2 times a day and 500 mg capsules of powdered ginger root in addition to a routine antiemetic regimen consisting of dexamethasone, metoclopramide and aprepitant (DMA) capsules. Chamomile group similarly was: 2 times a day and 500 mg capsules of Matricaria chamomilla extract in addition to a routine antiemetic regimen consisting of DMA capsules. Control group, routine antiemetic regimen consisting of DMA capsules. Results: There were no significant differences between the ginger, chamomile and control groups regarding age. Drugs used for chemotherapy were identical and duration of disease was also matched (1-4 months). Ginger and chamomile were both significantly effective for reducing the frequency of vomiting, there being no significant difference between the ginger and chamomile groups. Moreover, unlike the chamomile, ginger significantly influenced the frequency of nausea. Conclusions: According to the findings of this study, it should be declared that taking ginger capsules (1 g/day) might relieve CINV safely. Nurses dealing directly with cancer patients should be responsible for providing educational programs for patients and their families about how to deal with their drug regimens and associated side effects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.2
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• pp.84-89
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• 2016

Objectives: To compare the efficacy of intravenous ondansetron (4 mg, 2 mL) and granisetron (2 mg, 2 mL) for preventing postoperative nausea and vomiting (PONV) in patients during oral and maxillofacial surgical procedures under general anesthesia. Materials and Methods: A prospective, randomized, and double blind clinical study was carried out with 60 patients undergoing oral and maxillofacial surgical procedures under general anesthesia. Patients were divided into two groups of 30 individuals each. Approximately two minutes before induction of general anesthesia, each patient received either 4 mg (2 mL) ondansetron or 2 mg (2 mL) granisetron intravenously in a double blind manner. Balanced anesthetic technique was used for all patients. Patients were assessed for episodes of nausea, retching, vomiting, and the need for rescue antiemetic at intervals of 0-2, 3, 6, 12, and 24 hours after surgery. Incidence of complete response and adverse effects were assessed at 24 hours postoperatively. Data was tabulated and subjected to statistical analysis using the chi-square test, unpaired t-test, or the Mann-Whitney U-test as appropriate. A P-value less than 0.05 was considered statistically significant. Results: There was no statistically significant difference between the two groups for incidence of PONV or the need for rescue antiemetic. Both study drugs were well tolerated with minimum adverse effects; the most common adverse effect was headache. The overall incidence of complete response in the granisetron group (86.7%) was significantly higher than the ondansetron group (60.0%). Conclusion: Granisetron at an intravenous dose of 2 mg was found to be safe, well tolerated, and more effective by increasing the incidence of complete response compared to 4 mg intravenous ondansetron when used for antiemetic prophylaxis in maxillofacial surgery patients receiving general anesthesia. Benefits of granisetron include high receptor specificity and high potency, which make it a valuable alternative to ondansetron.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.203-207
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• 1997

Background: To date, there are no controlled studies assessing the effect of metoclopramide administered epidurally to prevent nausea and vomiting associated with epidural morphine for postoperative analgesia. This study was undertaken to determine the effectiveness of continuous epidural infusion of metoclopramide, combined with epidural morphine, in reducing nausea or vomiting associated with epidural morphine and minimizing the side effects of metoclopramide. Methods: Sixty patients undergoing elective gynecologic surgery were randomly assigned to one of two study groups. Patients received continuous epidural morphine infusion (6.0 mg/day) following a bolus loading dose of 3.0 mg (Group A), or epidural mixture of morphine (6.0 mg/day) plus metoclopramide (20 mg/day) following a bolus loading dose (morphine 3.0 mg, metoclopramide 10 mg)(Group B). For the first 24 postoperative hours, incidence of nausea or vomiting, need for antiemetic therapy, level of sedation, degree of pain and pruritus, and adverse effects associated with metoclopramide were evaluated. Result: Incidence of nausea or vomiting and number of patients who required antiemetic therapy were significantly less in Group B, than in Group A (P<0.05). There were no significant differences between groups with regard to adverse effects associated with metoclopramide such as sedation, extrapyramidal reaction and other side effects (P=NS). Conclusion: We conclude simultaneous titration of morphine and metoclopramide via epidural continuous infusion following epidural bolus injection of the mixture reduces nausea or vomiting associated with epidural morphine while preventing side effects of metoclopramide.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9627-9630
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• 2014

Background: Although efficacy of aprepitant for suppressing emesis associated with single-dose cisplatin has been demonstrated, there are limited data on the antiemetic effect of this oral neurokinin-1 receptor antagonist during daily administration of cisplatin. Accordingly, we investigated the efficacy and safety of aprepitant in patients with head and neck cancer (HNC) receiving combination therapy with cisplatin and 5-FU (FP therapy). Materials and Methods: Twenty patients with HNC were prospectively studied who received a triple antiemetic regimen comprising granisetron ($40{\mu}g/kg$ on Days 1-4), dexamethasone (8 mg on Days 1-4), and aprepitant (125 mg on day 1 and 80mg on days 2-5) with FP therapy (cisplatin $20mg/m^2$ on days 1-4; 5-FU $400mg/m^2$ on days 1-5) (aprepitant group). We also retrospectively studied another 20 HNC patients who received the same regimen except for aprepitant (control group). Results: For efficacy endpoints based on nausea, the aprepitant group showed significantly better results, including a higher rate of complete response (no vomiting and no salvage therapy) for the acute phase (p=0.0342), although there was no marked difference between the two groups with regard to percentage of patients in whom vomiting was suppressed. There were no clinically relevant adverse reactions to aprepitant. Conclusions: This study suggested that a triple antiemetic regimen containing aprepitant is safe and effective for HNC patients receiving daily cisplatin therapy.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.380-384
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• 1996

Background: To determine the effectiveness of continuous epidural infusion of droperidol, combined with epidural morphine, in reducing nausea or vomiting associated with epidural morphine and minimizing the side effects of droperidol, 48 patients undergoing elective thoracic surgery were randomly assigned to one of two study groups. Methods: Patients received continuous infusion of epidural morphine(6.0 mg/day) following a bolus loading dose of 3.0 mg(Group A), or epidural mixture of morphine(6.0 mg/day) plus droperidol(5.0 mg/day) following a bolus loading dose(morphine 3.0mg, droperidol 1.5 mg)(Group B). For the first 48 postoperative hours, the incidence of nausea or vomiting, the need for antiemetic therapy, level of sedation, and adverse effects associated with droperidol were evaluated. Results: The incidence of nausea or vomiting and the number of patients who required antiemetic therapy were significantly less in Group B than in Group A(P<0.05). There were no significant differences between groups with regard to the adverse effects associated with droperidol such as mental depression, respiratory depression and abnormal movements(P=NS). Conclusion: We conclude that simultaneous titration of morphine and droperidol via epidural continuous infusion following epidural bolus injection of the mixture reduces nausea or vomiting associated with epidural morphine while it prevents the side effects of droperidol.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7701-7706
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• 2013

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1% vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness. Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47). Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6207-6213
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• 2015

The supportive care of patients receiving antineoplastic treatment has dramatically improved over the past few years and development of effective measures to prevent nausea and vomiting after chemotherapy serves as one of the most important examples of this progress. A patient who starts cancer treatment with chemotherapy lists chemotherapy-induced nausea and vomiting as among their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life, increases the use of health care resources, and may occasionally compromise adherence to treatment. New insights into the pathophysiology of chemotherapy-induced nausea and vomiting, a better understanding of the risk factors for these effects, and the availability of new antiemetic agents have all contributed to substantial improvements in emetic control. This review focuses on current understanding of chemotherapy-induced nausea and vomiting and the status of pharmacological interventions for their prevention and treatment.