The Impact of Aprepitant on Post-Operative Nausea and Vomiting in Endoscopic Skull Base Surgery.

Abstract

Objective: Post-operative nausea and vomiting (PONV) is common following endoscopic skull base surgery despite multimodal prophylaxis and carries a risk of post-operative bleeding and cerebrospinal fluid (CSF) leakage. This study aims to investigate if pre-operative administration of the neurokinin-1 (NK-1) antagonist, aprepitant, reduces PONV in patients undergoing endoscopic skull base surgery.

Methods: A retrospective review of 58 patients undergoing endoscopic skull base surgery was performed. Demographic variables and clinical variables such as anesthesia type, procedural time, intraoperative CSF leak, and co-administration of other antiemetics were collected. Primary outcome was PONV events, defined as the documentation of nausea and/or vomiting in the medical record or use of rescue antiemetic therapy. Post-operative bleeding and CSF leaks were recorded. Univariate and multivariate analyses were conducted in R with the following covariates: co-administered antiemetics, TIVA use, smoking status, ASA score, procedural duration, and intraoperative CSF leak.

Results: Of patients who received aprepitant, 42.9% developed PONV compared to 43.2% in the non-aprepitant group. On univariate analysis, there was no difference in PONV (OR 0.98, p = 1.00), vomiting (OR 0.33, p = 0.30), or post-operative bleeding (OR 0.87, p = 1.00) between groups. Multivariate regression showed no association between PONV and aprepitant (OR 0.52, p = 0.32). Subgroup analysis of patients undergoing transsphenoidal surgery showed no association of PONV and aprepitant (OR 0.45, p = 0.34).

Conclusion: PONV occurs in nearly half of patients undergoing endonasal skull base surgery. Pre-operative administration of aprepitant was not associated with reduced risk of developing PONV.

Level of evidence: 3.