Aprepitant for attenuation of postoperative nausea and vomiting with a decrease in postoperative analgesic needs after laparoscopic surgery

Background Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Multiple drugs have been used to prevent its occurrence. Ondansetron and aprepitant block the emetic effect of serotonin and neurokinin, respectively. Corticosteroids are well known for their anti-inflammatory effects, but the basis behind their use as antiemetics is not well understood. Objective The aim was to investigate the effect of combining aprepitant with ondansetron and dexamethasone compared with ondansetron and dexamethasone alone on PONV in patients undergoing laparoscopic cholecystectomy. Patients and methods A total of 60 patients with American Society of Anesthesiologists physical status I/II undergoing laparoscopic cholecystectomy (with preoperative two or more Apfel four-point risk factors) were recruited into the study and were randomly divided into two equal groups. In both groups, dexamethasone was administered intravenously at the beginning of surgery, and ondansetron was administered intravenously at the end of surgery. In the aprepitant group, oral aprepitant was given 2 h before anesthesia with a sip of water. The primary outcome measure was complete response (no PONV and no rescue antiemetics) up to 24 h postoperatively. The secondary outcome measure was the amount of rescue postoperative analgesics given during the first 24 h postoperatively. Results There was a statistical significant difference between the two groups in complete response at the sixth hour after surgery. In the aprepitant group, none of the patient experienced a verbal numeric rating scale score greater than 3. Moreover, none of the patients of the aprepitant group had received rescue antiemetics during the first 24 h after surgery compared with the control group. In addition, no difference existed regarding postoperative pain score, although the score was slightly lower in the aprepitant group. Conclusion Oral aprepitant when combined with intravenous ondansetron and dexamethasone is effective in suppressing early PONV up to 24 h postoperatively.