Korean J Anesthesiol.  2012 Sep;63(3):221-226. 10.4097/kjae.2012.63.3.221.

The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone

• Lee SJ
• Lee SM
• Kim SI
• Ok SY
• Kim SH
• Park SY
• Kim MG

• KMID: 2236271
• DOI: http://doi.org/10.4097/kjae.2012.63.3.221

Abstract

BACKGROUND
The purpose of this study was to evaluate the effect of an aprepitant, neurokinin-1(NK1) receptor antagonist, for reducing postoperative nausea and vomiting (PONV) for up to 24 hours in patients regarded as high risk undergoing gynecological surgery with intravenous patient-controlled analgesia (IV PCA) using fentanyl.
METHODS
In this randomized, open label, case-control study 84 gynecological surgical patients receiving a standardized general anesthesia were investigated. Patients were randomly allocated to receive aprepitant 80 mg P.O. approximately 2-3 hours before operation (aprepitant group) or none (control group). All patients received ramosetron 0.3 mg IV after induction of anesthesia. The incidence of PONV, severity of nausea, and use of rescue antiemetics were evaluated for up to 24 hours postoperatively.
RESULTS
The incidence of nausea was significantly lower in the aprepitant group (50.0%) compared to the control group (80.9%) during the first 24 hours following surgery. The incidence of vomiting was significantly lower in the aprepitant group (4.7%) compared to the control group (42.8%) during the first 24 hours following surgery. In addition, the severity of nausea was less among those in the aprepitant group compared with the control group over a period of 24 hours post-surgery (P < 0.05). Use of rescue antiemetics was lower in the aprepitant group than in the control group during 24 hours postoperatively (P < 0.05).
CONCLUSIONS
In patients regarded as high risk undergoing gynecological surgery with IV PCA using fentanyl, the aprepitant plus ramosetron ware more effective than ramosetron alone to decrease the incidence of PONV, use of rescue antiemetics and nausea severity for up to 24 hours postoperatively.

Keyword

Aprepitant; Gynecologic anesthesia; Neurokinin-1 receptor; Patient controlled analgesia; Postoperative nausea and vomiting; Ramosetron

MeSH Terms

Analgesia, Patient-Controlled
Anesthesia
Anesthesia, General
Anesthesia, Obstetrical
Antiemetics
Benzimidazoles
Case-Control Studies
Female
Fentanyl
Gynecologic Surgical Procedures
Humans
Incidence
Morpholines
Nausea
Passive Cutaneous Anaphylaxis
Postoperative Nausea and Vomiting
Receptors, Neurokinin-1
Vomiting
Antiemetics
Benzimidazoles
Fentanyl
Morpholines
Receptors, Neurokinin-1