The Role of Aprepitant in Prevention of Postoperative Nausea and Vomiting After Bariatric Surgery
- 305 Downloads
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.
- 1.Weingarten TN, Hawkins NM, Beam WB, et al. Factors associated with prolonged anesthesia recovery following laparoscopic bariatric surgery: a retrospective analysis. Obes Surg. 2015;25(6):1024–30.Google Scholar
- 2.Sinha AC, Singh PM, Williams NW, et al. Aprepitant’s prophylactic efficacy in decreasing postoperative nausea and vomiting in morbidly obese patients undergoing bariatric surgery. Obes Surg. 2014;24(2):225–31.Google Scholar
- 3.Gan TJ, Diemunsch P, Habib AS, et al. Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85–113.Google Scholar
- 4.Apfel CC, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693–700.Google Scholar
- 5.Moon HY, Baek CW, Choi GJ, et al. Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial. BMC Anesthesiol. 2014;14:68.Google Scholar
- 6.Weingarten TN, Gurrieri C, McCaffrey JM, et al. Acute kidney injury following bariatric surgery. Obes Surg. 2013;23(1):64–70.Google Scholar
- 7.White PF, O’Hara JF, Roberson CR, et al. The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients. Anesth Analg. 2008;107(2):452–8.Google Scholar
- 8.Apfel CC, Korttila K, Abdalla M, et al. Impact investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441–51.Google Scholar
- 9.Leslie RA. Neuroactive substances in the dorsal vagal complex of the medulla oblongata: nucleus of the tractus solitarius, area postrema, and dorsal motor nucleus of the vagus. Neurochem Int. 1985;7(2):191–211.Google Scholar
- 10.Gralla RJ, Roila F, Tonato M, et al. The 2004 Perugia antiemetic consensus guideline process: methods, procedures, and participants. Support Care Cancer. 2005;13(2):77–9.Google Scholar
- 11.Gan TJ, Apfel CC, Kovac A, et al. Aprepitant Ponv study group. A randomized, double-blind comparison of the NK1 antagonist, aprepitant, versus ondansetron for the prevention of postoperative nausea and vomiting. Anesth Analg. 2007;104(5):1082–9.Google Scholar
- 12.Smith HS, Smith JM, Seidner P. Opioid-induced nausea and vomiting. Ann Palliat Med. 2012;1(2):121–9.Google Scholar
- 13.Habib AS, Keifer JC, Borel CO, et al. A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy. Anesth Analg. 2011;112(4):813–8.Google Scholar
- 14.Lee SJ, Lee SM, Kim SI, et al. The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone. Korean J Anesthesiol. 2012;63(3):221–6.Google Scholar
- 16.Weingarten TN, McGlinch BP, Liedl L, et al. Intranasal nicotine increases postoperative nausea and is ineffective in reducing pain following laparoscopic bariatric surgery in tobacco-naive females: a randomized, double blind trial. Obes Surg. 2015;25(3):506–13.Google Scholar
- 17.Weingarten TN, Bergan TS, Narr BJ, et al. Effects of changes in intraoperative management on recovery from anesthesia: a review of practice improvement initiative. BMC Anesthesiol. 2015;15:54.Google Scholar
- 18.Vallejo MC, Phelps AL, Ibinson JW, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Plast Reconstr Surg. 2012;129(2):519–26.Google Scholar
- 19.Gan TJ, Gu J, Singla N, et al. Rolapitant investigation group. Rolapitant for the prevention of postoperative nausea and vomiting: a prospective, double-blinded, placebo-controlled randomized trial. Anesth Analg. 2011;112(4):804–12.Google Scholar
- 21.Reference withheld for anonymous review.Google Scholar
- 22.Singh PM, Borle A, Rewari V, et al. Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis. Postgrad Med J. 2016 Feb;92(1084):87–98.Google Scholar