The Role of Aprepitant in Prevention of Postoperative Nausea and Vomiting After Bariatric Surgery
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Postoperative nausea and vomiting (PONV) is common with bariatric surgery. We examined the PONV rate in bariatric surgical patients who received triple antiemetic prophylaxis (dexamethasone, droperidol, and ondansetron) with and without antiemetic aprepitant.
Medical records of female patients undergoing laparoscopic bariatric surgery from January 1, 2014, to July 28, 2016, were reviewed for PONV episodes during 48 postoperative hours.
In total, 338 patients received triple antiemetic, of whom 172 (51%) also received aprepitant. Rates of PONV in the postanesthesia care unit (PACU) among patients with and without aprepitant therapy were 11 vs 17% (P = .09). Within 1 h after PACU discharge, fewer patients in the aprepitant group had PONV (19 vs 31%; odds ratio [OR] [95% CI], 0.5 [0.30–0.80]; P = .007). During the first 48 postoperative hours, PONV rates were similar between the groups (68 and 66%; P = .73), but fewer emesis episodes occurred in the aprepitant group (6 vs 13%; OR [95% CI], 0.45 [0.21–0.95]; P = .04). Analyses were also performed with a subset of patients matched on propensity for receiving aprepitant. In this subset, OR estimates quantifying aprepitant effect on PONV were similar to those obtained from multivariable regression analyses.
Addition of aprepitant to a multimodal antiemetic prophylactic regimen may be associated with significant reduction of PONV during early recovery and potentially with reduced incidence of vomiting during the first 48 postoperative hours. The high PONV rate in the first 48 postoperative hours is suggestive that introduction of scheduled anti-PONV prophylactic treatment may be desirable.
KeywordsAprepitant Bariatric surgery Postoperative nausea and vomiting
Obstructive sleep apnea
Postanesthesia care unit
Postoperative nausea and vomiting
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study. This study was approved by the institutional review board on May 5, 2015. Consistent with state statute, the study included only patients who had provided authorization for research use of their health records.
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