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Aprepitant prophylaxis effectively reduces preventing postoperative nausea and vomiting in patients receiving opioid based intravenous patient-controlled analgesia
Anesth Pain Med 2018;13(3):256-63
Published online July 31, 2018
© 2018 The Korean Society of Anesthesiologists.

Gwieun Yeo1, Mi Kyoung Lee1 , Heezoo Kim1, Myounghoon Kong1, Hyo Jung Son2, and Han Byeol Oh2
1Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 2Department of Anesthesia and Pain Medicine, National Police Hospital, Seoul, Korea
Correspondence to: Mi Kyoung Lee, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: 82-2-2626-1437 Fax: 82-2-2626-1438 E-mail: mknim@hotmail.com ORCID http://orcid.org/0000-0002-5603-1717
Received November 17, 2017; Revised March 15, 2018; Accepted March 20, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Aprepitant is effective in prevention of chemotherapy-induced nausea and vomiting, when administrated with other antiemetics. We compared the effectiveness of aprepitant to ondansetron for prevention of post-operative nausea and vomiting (PONV) in patients who received a patient-controlled analgesia (PCA) containing opioids.
Methods: 198 patients were randomized into two groups. The treatment group was received an aprepitant, 80 mg, and the control group received a placebo. General anesthesia with inhalational anesthetics–N2O was performed, and PCA was supplied, which contained opioids-NSAIDs-ondansetron. The primary end-point was the incidence of PONV for postoperative 48 hours, and the secondary end-point was the changes in the relationship between PONV incidence and risk factors.
Results: PONV incidence in the treatment group was lower than in the control group (18.6% [95% CI: 10.8–26.3], 33.3% [95% CI: 23.6–43.1], respectively, P = 0.021). Relative risk of PONV in the control group was 1.80 (95% CI: 1.08–3.00, P = 0.010). PONV scores peaked at around postoperative 6 hours, then gradually decreased in the control group but not in the treatment group, which showed lower values than the control group (P = 0.001), and no changing patterns were observed (P < 0.001). Risk factors analyzed were sex, surgery type, history of motion sickness or PONV, and smoking habits. Their effects of all risk factors except sex were abolished in the treatment group.
Conclusions: Prophylactic aprepitant with ondansetron was more effective than ondansetron- only regimen in preventing PONV after volatile anesthesia with opioid-containing PCA. Aprepitant abolished the effects of most of risk factors, so it could be efficacious in a high-risk PONV group.
Key Words : Aprepitant, Ondansetron, Postoperative nausea and vomiting, Pre-exposure prophylaxis.


July 2018, 13 (3)
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