The impact of Aprepitant on Nausea and Vomiting following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial.

Abstract

Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (PONV). We aimed to compare the effects of aprepitant on the incidence of PONV after LSG. In this double-blind, randomized controlled trial, the case group received the standard care regimen for PONV (dexamethasone 10mg, ondansetron 4mg, and metoclopramide 10mg) plus prophylactic oral aprepitant 80mg 1h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24h postoperatively. A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less PONV: early, 69 (34.3%) vs. 103 (51.7%), p ≤ 0.001; 6h, 67 (33.3%) vs. 131 (65.8%), p ≤ 0.001; 12h, 41 (20.4%) vs. 115 (57.8%), p ≤ 0.001; and 24h, 22 (10.9%) vs. 67 (33.7%), p ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p = 0.020; 6h, 6 (3%) vs. 18 (9%), p = 0.020; 12h, 2 (1%) vs. 17 (8.5%), p = 0.006; and 24h, 1 (0.5%) vs. 6 (3%), p = 0.040. Patients in the aprepitant group required less additional PONV medication: early, 61 (30.3%) vs. 86 (43.2), p = 0.008; 6h, 7 (3.5%) vs. 34 (17%), p = 0.001; 12h, 6 (3%) vs. 31 (15.6%), p ≤ 0.001; and 24h, 5 (2.5%) vs. 11 (5.5%), p ≤ 0.001. Prophylactic aprepitant improved PONV between 0h (early) and 24h postoperatively in patients undergoing LSG.