Obesity Surgery

, Volume 24, Issue 2, pp 225–231

Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery

  • Ashish C. Sinha
  • Preet Mohinder Singh
  • Noel W. Williams
  • Edward Andrew Ochroch
  • Basavana G. Goudra
Original Contributions

DOI: 10.1007/s11695-013-1065-1

Cite this article as:
Sinha, A.C., Singh, P.M., Williams, N.W. et al. OBES SURG (2014) 24: 225. doi:10.1007/s11695-013-1065-1

Abstract

Background

Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.

Methods

After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.

Results

Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3 %) compared to group P (15 %; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan–Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67 %). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.

Conclusions

In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.

Keywords

Aprepitant in morbidly obese Postoperative nausea and vomiting prophylaxis in bariatric surgery PONV prophylaxis in morbidly obese 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ashish C. Sinha
    • 1
  • Preet Mohinder Singh
    • 2
  • Noel W. Williams
    • 3
  • Edward Andrew Ochroch
    • 4
  • Basavana G. Goudra
    • 4
  1. 1.Anesthesiology and Perioperative MedicineDrexel University College of MedicinePhiladelphiaUSA
  2. 2.Department of AnesthesiaPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Clinical SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Anesthesiology and Critical Care MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA

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