{"title":"预防腹腔镜袖胃切除术后恶心呕吐的随机对照试验:阿瑞吡坦/地塞米松vs米氮平/地塞米松","authors":"Tarek M Ashoor, Dina Y Kassim, Ibrahim M Esmat","doi":"10.1155/2022/3541073","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (<i>D</i>) alone for prevention of PONV in morbidly obese patients undergoing LSG.</p><p><strong>Methods: </strong>Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the <i>D</i> group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.</p><p><strong>Results: </strong>The A/D and M/D groups were superior to the <i>D</i> group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the <i>D</i> group). The <i>D</i> group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (<i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the <i>D</i> group (<i>P</i>=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (<i>P</i> < 0.001, <i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The A/D and M/D groups were superior to the <i>D</i> group with regard to the patient satisfaction score (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2022 1","pages":"3541073"},"PeriodicalIF":1.6000,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9078838/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone.\",\"authors\":\"Tarek M Ashoor, Dina Y Kassim, Ibrahim M Esmat\",\"doi\":\"10.1155/2022/3541073\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (<i>D</i>) alone for prevention of PONV in morbidly obese patients undergoing LSG.</p><p><strong>Methods: </strong>Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the <i>D</i> group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.</p><p><strong>Results: </strong>The A/D and M/D groups were superior to the <i>D</i> group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the <i>D</i> group). The <i>D</i> group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (<i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the <i>D</i> group (<i>P</i>=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (<i>P</i> < 0.001, <i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The A/D and M/D groups were superior to the <i>D</i> group with regard to the patient satisfaction score (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.</p>\",\"PeriodicalId\":7834,\"journal\":{\"name\":\"Anesthesiology Research and Practice\",\"volume\":\"2022 1\",\"pages\":\"3541073\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2022-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9078838/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anesthesiology Research and Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2022/3541073\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesiology Research and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2022/3541073","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景不同止吐药联合应用可减少腹腔镜袖胃切除术后恶心呕吐(PONV)。该试验比较了阿瑞吡坦/地塞米松(A/D)联合用药与米氮平/地塞米松(M/D)联合用药与单独地塞米松(D)治疗对行LSG的病态肥胖患者PONV的预防作用。方法90例LSG患者随机分为两组，D组仅静脉输注地塞米松8mg, A/D组加80mg阿瑞吡坦胶囊，M/D组加30mg米氮平片。在0-2 h(早期)和2-24 h(晚期)进行PONV评估。主要终点是手术后0 - 24小时的完全缓解。综合PONV、术后疼痛、副作用和患者满意度评分作为次要结局。结果A/D组和M/D组术后0 ~ 24 h内完全缓解率均优于D组(A/D组为79.3%，M/D组为78.6%，D组为20.7%)。D组在术后0 ~ 24 h的集体PONV和抢救止吐药使用方面均低于A/D组和M/D组(P < 0.001, P < 0.001)。与D组相比，M/D组的恶心高峰评分(2-24 h)显著降低(P=0.005)。M/D组患者镇静评分较高，而A/D组患者疼痛评分较低(2-24 h)，镇痛需求较少(P < 0.001, P < 0.001, P < 0.001)。A/D组和M/D组患者满意度评分优于D组(P < 0.001)。结论阿瑞吡坦/地塞米松联合用药及米氮平/地塞米松联合用药对缓解病态性肥胖患者腹腔镜袖胃切除术后恶心呕吐的效果优于单用地塞米松。试验注册:ClinicalTrials.gov标识符:NCT04013386。
A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone.
Background: Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG.
Methods: Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.
Results: The A/D and M/D groups were superior to the D group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001).
Conclusion: Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.
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