Abstract
BackgroundThe incidence of postoperative nausea and vomiting (PONV) is 50% to 80% after neurosurgery. The common prophylactic treatment for postoperative nausea and vomiting is a triple therapy of droperidol, promethazine and dexamethasone. Newer, more effectives methods of prophylaxis are being investigated. We designed this prospective, double-blind, single-center study to compare the efficacy of ondansetron, a neurokinin-1 antagonist, and aprepitant, as a substitute for droperidol, in the prophylactic treatment of postoperative nausea and vomiting after neurosurgery.MethodsAfter obtaining institutional review board approval; 176 patients, 18 to 85 years of age with American Society of Anesthesiologists (ASA) classifications I to III, who did not receive antiemetics 24 h before surgery and were expected to undergo general anesthesia for neurosurgery lasting longer than 2 h were included in this study. After meeting the inclusion and exclusion criteria and providing written informed consent, patients were randomly assigned in a 1:1 ratio to one of two treatment groups: aprepitant or ondansetron. The objective of this study was to conduct a randomized, double-blind, double-dummy, parallel-group and single-center trial to compare and evaluate the efficacies of aprepitant versus ondansetron. Patients received oral aprepitant 40 mg OR oral dummy pill within 2 h prior to induction. At induction, a combination of intravenous dexamethasone 10 mg, promethazine 25 mg, and ondansetron 4 mg OR dummy injection was administered. Therefore, all patients received one dummy treatment and three active PONV prophylactic medications: dexamethasone 10 mg, promethazine 25 mg, and either aprepitant 40 mg OR ondansetron 4 mg infusion. The primary outcome measures were the episodes and severity of nausea and vomiting; administration of rescue antiemetic; and opioid consumption for 120 h postoperatively. Standard safety assessments included adverse event reports, physical and laboratory data, awakening time and duration of recovery from anesthesia.DiscussionThe results of this comparative study could potentially identify an improved treatment regimen that may decrease the incidence and severity of postoperative nausea and vomiting in patients undergoing neurosurgery. Also, this will serve to enhance patient recovery and overall satisfaction of neurosurgical patients in the immediate postoperative period.Trial registrationRegistered at The Ohio State University Biomedical Sciences Institutional Review Board: Protocol Number: 2007 H0053
Highlights
The incidence of postoperative nausea and vomiting (PONV) is 50% to 80% after neurosurgery
We hypothesized a significantly greater percentage of neurosurgery patients will experience no vomiting during the immediate 48-h postoperative period in the prophylactic aprepitant triple therapy group
This study could potentially identify an improved prophylaxis for PONV for patients undergoing neurosurgery
Summary
The incidence of postoperative nausea and vomiting (PONV) is 50% to 80% after neurosurgery. More effectives methods of prophylaxis are being investigated. We designed this prospective, double-blind, single-center study to compare the efficacy of ondansetron, a neurokinin-1 antagonist, and aprepitant, as a substitute for droperidol, in the prophylactic treatment of postoperative nausea and vomiting after neurosurgery. The overall incidence of postoperative nausea and vomiting (PONV) is around 30% and as great as 70% to 80% in high-risk individuals [1]. For patients undergoing neurosurgery the PONV incidence is about 50% to 80%. Indicators for increased risk of PONV with craniotomy surgery includes: infratentorial lesion, female gender and children older than 2 years of age [2]. Patients in the early postoperative period after craniotomy surgery experiencing hypertension have an increased mortality if they develop intracranial hemorrhage [3]. PONV results in patient discomfort and dissatisfaction, the need for a larger nurse-to-patient ratio, increased post-anesthesia care unit (PACU) times, unintended admissions, extended postoperative stays and increased overall healthcare costs [1]
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