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Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery

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Abstract

Background

Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.

Methods

After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.

Results

Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3 %) compared to group P (15 %; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan–Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67 %). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.

Conclusions

In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.

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References

  1. Macario A, Weinger M, Carney S, et al. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89(3):652–8.

    CAS  PubMed  Google Scholar 

  2. Gan TJ, Sinha AC, Kovac AL, et al. A randomized, double-blind, multicenter trial comparing transdermal scopolamine plus ondansetron to ondansetron alone for the prevention of postoperative nausea and vomiting in the outpatient setting. Anesth Analg. 2009;108(5):1498–504.

    Article  CAS  PubMed  Google Scholar 

  3. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Moussa AA, Oregan PJ. Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery—granisetron alone vs granisetron combined with dexamethasone/droperidol. Middle East J Anesthesiol. 2007;19(2):357–67.

    PubMed  Google Scholar 

  5. Scuderi PE, Conlay LA. Postoperative nausea and vomiting and outcome. Int Anesthesiol Clin. 2003;41(4):165–74.

    Article  PubMed  Google Scholar 

  6. Gan TJ, Apfel CC, Kovac A, et al. 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. Tables of contents.

    Article  CAS  PubMed  Google Scholar 

  7. Diemunsch P, Apfel C, Gan TJ, et al. Preventing postoperative nausea and vomiting: post hoc analysis of pooled data from two randomized active-controlled trials of aprepitant. Curr Med Res Opin. 2007;23(10):2559–65.

    Article  CAS  PubMed  Google Scholar 

  8. Apfel CC, Philip BK, Cakmakkaya OS, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012;117(3):475–86.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. Gan TJ, Gu J, Singla N, et al. Rolapitant for the prevention of postoperative nausea and vomiting: a prospective, double-blinded, placebo-controlled randomized trial. Anesth Analg. 2011;112(4):804–12.

    Article  CAS  PubMed  Google Scholar 

  12. Gesztesi Z, Scuderi PE, White PF, et al. Substance P (neurokinin-1) antagonist prevents postoperative vomiting after abdominal hysterectomy procedures. Anesthesiology. 2000;93(4):931–7.

    Article  CAS  PubMed  Google Scholar 

  13. Lim CS, Ko Y-K, Kim Y-H, et al. Efficacy of the oral neurokinin-1 receptor antagonist aprepitant administered with ondansetron for the prevention of postoperative nausea and vomiting. Korean J Anesth. 2013;64(3):212–7.

    Article  CAS  Google Scholar 

  14. Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol. 2005;19(3):485–500.

    Article  CAS  PubMed  Google Scholar 

  15. Lopez PP, Stefan B, Schulman CI, et al. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74(9):834–8.

    PubMed  Google Scholar 

  16. Smith S, Hampson F, Sinclair M. The surgical management of obesity with emphasis on the role of post operative imaging. Biomed Imaging Interv J. 2011;7(1):e8. doi:10.2349/biij.7.1.e8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107690/.

    PubMed Central  PubMed  Google Scholar 

  17. Ogunnaike BO, Jones SB, Jones DB, et al. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95(6):1793–805.

    Article  PubMed  Google Scholar 

  18. Wallenborn J, Rudolph C, Gelbrich G, et al. The impact of isoflurane, desflurane, or sevoflurane on the frequency and severity of postoperative nausea and vomiting after lumbar disc surgery. J Clin Anesth. 2007;19(3):180–5.

    Article  CAS  PubMed  Google Scholar 

  19. Karlsen KL, Persson E, Wennberg E, et al. Anaesthesia, recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia. Acta Anaesthesiol Scand. 2000;44(4):489–93.

    Article  CAS  PubMed  Google Scholar 

  20. **dal R, Kumra VP, Narani KK, et al. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian J Anaesth. 2011;55(1):36–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102(6):1884–98.

    Article  PubMed  Google Scholar 

  22. Ebell MH. Predicting postoperative nausea and vomiting. Am Fam Physician. 2007;75(10):1537–8.

    PubMed  Google Scholar 

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Acknowledgments

Dr Ashish Sinha received a grant from “Merck & Co., Inc., Whitehouse Station, NJ, USA” for the conduct of this study.

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Authors and Affiliations

  1. Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA

    Ashish C. Sinha

  2. Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Preet Mohinder Singh

  3. Department of Clinical Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Noel W. Williams

  4. Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Edward Andrew Ochroch & Basavana G. Goudra

Authors
  1. Ashish C. Sinha
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  2. Preet Mohinder Singh
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  4. Edward Andrew Ochroch
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  5. Basavana G. Goudra
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Correspondence to Ashish C. Sinha.

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Sinha, A.C., Singh, P.M., Williams, N.W. et al. Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery. OBES SURG 24, 225–231 (2014). https://doi.org/10.1007/s11695-013-1065-1

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  • DOI: https://doi.org/10.1007/s11695-013-1065-1

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