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Postoperative nausea & vomiting (PONV)

Acacia Pharma 2019 ASRA Symposium

PONV is a common complication of surgery, occurring in approximately 30% of surgical patients and up to 80% of high-risk patients. It is associated with the use of anesthetic gases and opioid pain-killers and is particularly common following gynecological, abdominal, breast, eye and ear operations, especially those lasting an hour or more.

The Group estimates that approximately 65 million surgical procedures are conducted in the US each year that require injectable analgesia and are eligible for antiemetic use to prevent PONV. Based on market research, Acacia Pharma estimates that the total market in the US for prophylactic and rescue treatment comprises an estimated 34 million treatment events annually.

PONV has been ranked as the most undesirable of all surgical complications by patients and contributes significantly to patient anxiety and distress. PONV can delay hospital discharge; result in re-admission after in-patient procedures; and lead to day-case patients being admitted to hospital, all of which can result in significantly increased healthcare costs.

In addition, The Patient Protection and Affordable Care Act of 2010 (“Affordable Care Act”) in the US has linked quality of care and patient satisfaction to reimbursement. Appropriate management of PONV is key to improving patient satisfaction scores and therefore new treatment options could provide opportunities for reimbursement as well as for reducing healthcare costs.

Procedural sedation/induction

Procedural sedation/induction is a technique in which a sedative is given, usually along with an analgesic, in order to perform invasive non-surgical procedures on a patient. The goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own and their airway’s protective reflexes. 

Procedural sedation is used in a range of invasive procedures, such as colonoscopy and bronchoscopy. Approximately 25 million such procedures take place annually in the US, of which ~90% use moderate sedation.

Chemotherapy-induced nausea & vomiting (CINV)

CINV is one of the most common and feared side effects of cancer chemotherapy. In patients receiving highly emetogenic chemotherapy (e.g. cisplatin or anthracycline-cyclophosphamide combinations in breast cancer) the incidence of CINV is over 90%. There are also many moderately emetogenic chemotherapy agents and regimens which can cause CINV in 30-90% of patients.

Nausea and vomiting can occur on the day of chemotherapy (acute CINV) and can persist for two to five days after chemotherapy (delayed CINV). CINV has a significant effect on quality of life and can compromise patient health. Severe CINV may necessitate a delay or reduction in chemotherapy and can ultimately lead to the withdrawal of treatment. The goal of CINV management is the prevention, rather than treatment, of symptoms.