Namık ÖZCAN, Ayşe ÖZCAN, Ayşegül CEYHAN, Zeki SANDIKÇI, Bülent BALTACI

Combination of transcutaneous electrical nerve stimulation and ondansetron for prevention of chemotherapy-induced emesis in genitourinary tumors

Genitoüriner Sistem Tümörlerinde Kemoterapi Kaynaklı Emezisin Önlenmesinde Transkütanöz Elektriksel Sinir Stimülasyonu (Tens) İle Ondansetron Kombinasyonu Amaç:Çalışmamızdakemoterapialanhastalardatranskütanöz elektriksel sinir stimülasyonu (TENS)'nun antiemetik etkinliği ve TENS ile ondansetron kombinasyonunun daha güçlü antiemetik etki oluşturup oluşturmadığı araştırıldı. Gereç ve Yöntem:Çalışma grupları BEP (Bleomisin, Etoposid, Sisplatin)kemoterapisiplanlanan14testistümörlüveMVEC (Metotreksat, Vinblastin, Epirubisin, Sisplatin) kemoterapisi planlanan 11 mesane tümörlü hastadan oluşturuldu. Her olgunun üç siklusu randomize edilerek kemoterapisırasında antiemetik tedavi olarak TENS,ondansetron,TENS+ondansetronuygulandı.Hastalardan antiemetik tedavi esnasındaki bulantılarını 0-10 arasında değişen bir skala ile değerlendirmeleri istendi. Ek olarak hastaların emetik atakları kaydedildi. Bulgular: Her iki grupta ondansetron + TENS kombinasyonunun bulantıyı azaltmada ve emetik atakları önlemede tek başına TENS ve ondansetrona göre daha etkin olduğu bulundu (p< 0.05). Antiemetik tedaviye yanıt Ki kare testi ile her iki grup içi karşılaştırıldığında, tek başına ondansetronun tek başına TENS'ten ve ondansetron + TENS kombinasyonunun tek başına ondansetrondan her iki grupta da daha etkin olduğu saptandı. Sonuç:Tek başına ondansetron kullanımınınhastalartarafından kabul edilebilir antiemetik etkinliğe sahip olduğu, TENS'in tek başına kullanımının minör bir antiemetik etkinlik gösterdiği, ancak ondansetrona ek olarak TENS kullanımının kemoterapiye bağlı bulantı ve kusma ataklarının önlenmesinde en yüksek etkinliğe sahip olduğu sonucuna varıldı.

Genitoüriner sistem tümörlerinde kemoterapi kaynaklı emezisin önlenmesinde transkütanöz elektriksel sinir stimülasyonu (tens) ile ondansetron kombinasyonu

We assessed the antiemetic effect of transcutaneous electrical nervestimulation(TENS)andwhetheranondansetron-TENS combination has a stronger antiemetic effect in patients receiving chemotherapy. Methods: Two study groups were formed from 14 testis tumor patients scheduled for BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy and 11 urinary bladder tumor patients scheduled for MVEC (Methotrexate, Vinblastine, Epirubicin, Cisplatin) chemotherapy. For three cycles of each chemotherapy regimen, TENS, ondansetron or ondansetron+TENS was applied randomly to each patient as an antiemetic therapy. Patients were asked to grade their nausea using a zero to ten scale during this therapy. In addition, the antiemetic attacks of each patient were registered. Results: The ondansetron+TENS combination was significantly more effective than TENS and ondansetron alone for reducing nausea and preventing emetic attacks in both groups (p

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Wyngaarden JB, Smith LH, Bennett JC. Cecil Textbook of medicine. Philadelphia: WB. Saunders Company; 1992.
Costall B, Domeney AM, Naylor RJ, Tattersal FD. 5-Hydoxytryptamine M-receptor antagonism to prevent cisplatin-induced emesis.Neuropharmacology 1986; 25:959-961.
Andrews PL, Rapeport WG, Sanger GJ. Neuropharmacology of emesis induced by anti-cancer therapy. Trends Pharmacol Sci 1988; 9:334-341.
Hawthorn J, Ostler KJ, Andrews PL. The role of abdominal visceral innervation and 5-Hydroxytriptamine M-receptors in vomiting induced by the cytotoxic drugs cyclophosphamide and cisplatin in the ferret. Q J Exp Physiol 1988; 73: 7-21.
Higgins GA, Kilpatrick GJ, Bunce KT, Jones BJ, Tyers MB. 5-HT3 receptor antagonists injected into the area postrema inhibit cisplatininduced emesis in the ferret. Br J Pharmacol 1989; 97: 247-255.
Milne RJ, Heel RC. Ondansetron. Therapeutic use as an antiemetic. Drugs 1991; 41:574-595.
Lichter I. Nausea and vomiting in patients with cancer. Hematol Oncol Clin North Am 1996; 10: 207-220.
Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia 1994; 49 (supp): 2-5.
Beal MW. Acupuncture and acupressure. Applications to women's reproductive health care. J Nurse Midwifery 1999; 44(3): 217-230.
Dundee JW, Chestnutt WN, Ghaly RG, Lynas AG. Traditional Chinese acupuncture: a potentially useful antiemetic? Br Med J 1986;293:583-584.
Ho CM, Hseu SS, Tsai SK, Lee TY. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for postcaesarean section pain relief. Acta Anaesthesiol Scand 1996; 40:372-375.
Dundee JW, Ghaly RG, Fitzpatrick KT, Lynch GA, Abram WP. Acupuncture to prevent cisplatin-associated vomiting. Lancet 1987; 1:1083.
De Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by Neiguan point acupressure. Obstet Gynecol 1992;80(5): 852-854.
Claybon L. Single dose intravenous ondansetron for the 24-hour treatment of postoperative nausea and vomiting. Anaesthesia 1994; 49 (suppl): 24-29.
McMillan C, Dundee JW, Abram WP. Enhancement of antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 1991; 64(5): 971- 972.
Perez EA, Hesketh PJ, Gandara DR. Serotonin antagonists in the management of cisplatin-induced emesis. Semin Oncol 1991; 18: 73-80.
Cubeddu LX, Hoffman IS, Fuenmayor NT, Finn AL. Efficacy of on dansetron (GR 38032F) and the role of serotonin in cisplatin-induced nausea and vomiting. N Engl J Med 1990; 322: 810-816.
Grunberg SM, Stevenson LL, Russell CA, McDermed JE. Dose ranging phase I study of the serotonin antagonist GR38032F for pre vention of cisplatin induced nausea and vomiting. J Clin Oncol 1989; 7(8): 1137-1141.
Sailer R, Hellenbrecht D, Buhring M, Hess H. Enhancement of the antiemetic action of metoclopramide against cisplatin induced em esis by transdermal electrical nerve stimulation. J Clin Pharmacol 1986; 26: 115-119.
Dundee JW, Yang J, McMillan C. Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 1991; 84(4): 210-212.
Helms JM. The basic, clinical and speculative science of acupuncture. In. Helms JM (ed): Acupuncture energetics. A clinical approach for physicians. Berkeley, Medical Acupuncture Publishers, 1995. p.20-39.
Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: A meta analysis. AnesthAnalg 1999; 88(6): 1362-1369.
Yang LC, Jawan B, Chen CN, Ho RT, Chang KA, Lee JH. Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecologicallaparascopy. Acta Anaesthesiol Scand 1993; 37: 192-194.
Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KT, Ly nas AG. Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth 1989; 63(5): 612-618.
Stein DJ, Birnbach DJ, Danzer BI, Kuroda MM, Grunebaum A, Thys DM. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anaesthesia for cesarean section. Anesth Analg 1997; 84(2): 342-345.
Pearl ML, Fischer M, McCauley DL, Valea FA, Chalas E. Trans- cutaneous electrical nerve stimulation as an adjunct for controlling chemotherapy-induced nausea and vomiting in gynecologic oncology patients. Cancer Nurs 1999; 22(4): 307-311