Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy

Abstract

The use of opioids following surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). We conducted a prospective, randomized, double-blind, placebo-controlled study to investigate the effect of orally administered aprepitant, a neurokinin-1 receptor antagonist, for reducing PONV in patients with fentanyl-based, patient-controlled analgesia (PCA) given intravenously after gynecological laparoscopy. One hundred and twenty female patients (ages 21-60) undergoing laparoscopic hysterectomy were randomly allocated to receive 80mg (A80 group, n=40) or 125mg aprepitant (A125 group, n=40) or placebo (control group, n=40) orally 2h before anesthesia induction. Anesthesia was maintained with isoflurane and remifentanil, and PCA IV using fentanyl and ketorolac were provided for 48h after surgery. Incidences of nausea, vomiting/retching, and use of rescue antiemetics were recorded at 2, 24, and 48h after surgery. Complete response was defined as no PONV and no need for rescue treatment. The incidence of complete response was significantly lower in the A80 and A125 groups than in controls, 56% and 63%, vs. 28%, respectively, P=0.007 and P=0.003, respectively, during the first 48h, and 65% and 65% vs. 38%, respectively, both P=0.025, during the first 2h. However, there were no statistically significant differences between A80 and A125 groups in the incidences of complete response and PONV during the study period. Aprepitant 80mg orally was effective in lowering the incidence of PONV in the first 48h after anesthesia in patients receiving fentanyl-based PCA after gynecological laparoscopy.