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The impact of Aprepitant on Nausea and Vomiting following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial

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Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (PONV). We aimed to compare the effects of aprepitant on the incidence of PONV after LSG.

Methods

In this double-blind, randomized controlled trial, the case group received the standard care regimen for PONV (dexamethasone 10 mg, ondansetron 4 mg, and metoclopramide 10 mg) plus prophylactic oral aprepitant 80 mg 1 h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24 h postoperatively.

Results

A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less PONV: early, 69 (34.3%) vs. 103 (51.7%), p ≤ 0.001; 6 h, 67 (33.3%) vs. 131 (65.8%), p ≤ 0.001; 12 h, 41 (20.4%) vs. 115 (57.8%), p ≤ 0.001; and 24 h, 22 (10.9%) vs. 67 (33.7%), p ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p = 0.020; 6 h, 6 (3%) vs. 18 (9%), p = 0.020; 12 h, 2 (1%) vs. 17 (8.5%), p = 0.006; and 24 h, 1 (0.5%) vs. 6 (3%), p = 0.040. Patients in the aprepitant group required less additional PONV medication: early, 61 (30.3%) vs. 86 (43.2), p = 0.008; 6 h, 7 (3.5%) vs. 34 (17%), p = 0.001; 12 h, 6 (3%) vs. 31 (15.6%), p ≤ 0.001; and 24 h, 5 (2.5%) vs. 11 (5.5%), p ≤ 0.001.

Conclusions

Prophylactic aprepitant improved PONV between 0 h (early) and 24 h postoperatively in patients undergoing LSG.

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Authors and Affiliations

  1. Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico

    Elías Ortiz, Alberto I. González, Valeria Jaime, José A. Guzmán, Isaac Esparza, José O. Orozco, Almino Ramos & Carlos Zerrweck

  2. Anesthesiology department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico

    Manuel A. Guerrero

Authors
  1. Elías Ortiz
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  2. Alberto I. González
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  3. Valeria Jaime
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Corresponding author

Correspondence to Carlos Zerrweck.

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Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Authors Elías Ortiz, Alberto I. González, Valeria Jaime, José A Guzmán, Isaac Esparza, José O. Orozco, Manuel A Guerrero, Almino Ramos and Carlos Zerrweck declare no commercial associations or conflicts of interest.

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Key Point

• Laparoscopic sleeve gastrectomy is associated with postoperative nausea and vomiting.

• The study compared aprepitant to placebo in a blinded-randomized fashion.

• Aprepitant improved postoperative nausea and vomiting between 0 and 24 h post-LSG.

Appendix

Appendix

Table 

Table 6 Rhodes index for PONV (evaluation at 0, 6, 12, 24 h)
Full size table

6

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Ortiz, E., González, A.I., Jaime, V. et al. The impact of Aprepitant on Nausea and Vomiting following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial. OBES SURG 34, 1316–1323 (2024). https://doi.org/10.1007/s11695-024-07129-0

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