BACKGROUND:Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery. METHODS: After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h. RESULTS: Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3%) compared to group P (15%; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan-Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67%). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points. CONCLUSIONS: In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.
RCT Entities:
BACKGROUND:Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obesepatients for laparoscopic bariatric surgery. METHODS: After institutional review board approval, 125 morbidly obesepatients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h. RESULTS: Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3%) compared to group P (15%; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan-Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67%). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points. CONCLUSIONS: In morbidly obesepatients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.
Authors: Tong J Gan; Jiezhun Gu; Neil Singla; Frances Chung; Michael H Pearman; Sergio D Bergese; Ashraf S Habib; Keith A Candiotti; Yi Mo; Susan Huyck; Mary R Creed; Marc Cantillon Journal: Anesth Analg Date: 2011-03-08 Impact factor: 5.108
Authors: Tong J Gan; Christian C Apfel; Anthony Kovac; Beverly K Philip; Neil Singla; Harold Minkowitz; Ashraf S Habib; Jennifer Knighton; Alexandra D Carides; Hong Zhang; Kevin J Horgan; Judith K Evans; Francasca C Lawson Journal: Anesth Analg Date: 2007-05 Impact factor: 5.108
Authors: Tong J Gan; Ashish C Sinha; Anthony L Kovac; R Kevin Jones; Stephen A Cohen; Jean P Battikha; Jonathan S Deutsch; Joseph V Pergolizzi; Peter S A Glass Journal: Anesth Analg Date: 2009-05 Impact factor: 5.108
Authors: Isaac W Therneau; Erin E Martin; Juraj Sprung; Todd A Kellogg; Darrell R Schroeder; Toby N Weingarten Journal: Obes Surg Date: 2018-01 Impact factor: 4.129