Prevention of Postoperative Nausea and Vomiting in Elective Hysterectomy: A Prospective, Randomized, Placebo Controlled Outcomes Trial of Aprepitant NK-1-Receptor Antagonist

DOI: 10.4236/ojanes.2014.412043   PDF   HTML   XML   3,954 Downloads   4,446 Views   Citations

Abstract

Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.

Share and Cite:

Long, J. , Galdi, L. , Hentz, J. , Leslie, J. , Magtibay, P. , Kho, R. , Cornella, J. and Magrina, J. (2014) Prevention of Postoperative Nausea and Vomiting in Elective Hysterectomy: A Prospective, Randomized, Placebo Controlled Outcomes Trial of Aprepitant NK-1-Receptor Antagonist. Open Journal of Anesthesiology, 4, 301-307. doi: 10.4236/ojanes.2014.412043.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Apfel, C.C., Leara, E., Koivuranta, M., et al. (1999) A Simplified Risk Score for Predicting Nausea and Vomiting: Conclusions and Cross-Validations between Two Centers. Anesthesiology, 91, 693-700.
http://dx.doi.org/10.1097/00000542-199909000-00022
[2] Gan, T.J. (2006) Risk Factors for Postoperative Nausea and Vomiting. Anesthesia & Analgesia, 102, 1884-1898.
http://dx.doi.org/10.1213/01.ANE.0000219597.16143.4D
[3] Watcha, M.F. and White, P.F. (1992) Postoperative Nausea and Vomiting: Its Etiology, Treatment, and Prevention. Anesthesiology, 77, 162-168.
http://dx.doi.org/10.1097/00000542-199207000-00023
[4] Flemm, L.A. (2004) Aprepitant for Chemotherapy-Induced Nausea and Vomiting. Journal of Clinical Oncology, 8, 303-306.
[5] de Wit, R., et al. (2004) The Oral NK-1 Antagonist, Aprepitant, Given with Standard Antiemetics Provides Protection Against Nausea and Vomiting over Several Cycles of Cisplatin-Based Chemotherapy. European Journal of Cancer, 40, 403-407.
http://dx.doi.org/10.1016/j.ejca.2003.08.028
[6] Chawla, S.P., et al. (2003) Establishing the Dose of the Oral NK-1 Antagonist Aprepitant for the Prevention of Chemotherapy Induced Nausea and Vomiting. Cancer, 97, 2290-2300.
http://dx.doi.org/10.1002/cncr.11320
[7] Stahl, S.M. (2003) The Ups and Downs of Novel Antiemetic Drugs. Journal of Clinical Psychiatry, 64, 498-499.
http://dx.doi.org/10.4088/JCP.v64n0501
[8] Dando, T.M. and Perry, C.M. (2004) Aprepitant: A Review of Its Use in the Prevention of Chemotherapy-Induced Nausea and Vomiting. Drugs, 64, 777-794.
http://dx.doi.org/10.2165/00003495-200464070-00013
[9] Navari, R.M. (2004) Aprepitant: A NK-1 Receptor Antagonist for Chemotherapy-Induced Nausea and Vomiting. Expert Review Anticancer Therapy, 4, 715-724.
http://dx.doi.org/10.1586/14737140.4.5.715
[10] Jordan, K. (2006) Neurokinin-1-Receptor Anatagonists: A New Approach to Antiemetic Therapy. Onkologie, 29, 39-43.
http://dx.doi.org/10.1159/000089800
[11] Massaro, A.M. and Lenz, K.L. (2005) Aprepitant: A Novel NK-1 Receptor Antagonist for Chemotherapy-Induced Nausea and Vomiting. The Annals of Pharmacotherapy, 39, 77-85.
http://dx.doi.org/10.1345/aph.1E242
[12] Patel, L. and Lindley, C. (2003) Aprepitant: A Novel NK-1 Receptor Anatgonist. Expert Opinion on Pharmacotherapy, 4, 2279-2296.
http://dx.doi.org/10.1517/14656566.4.12.2279
[13] Merck & Co., Inc. (2003) Emend: Highlights of Prescribing Information.
http://www.merck.com/product/usa/pi_circulars/e/emend/emend_pi.pdf?WT.mc_id=N02N3
[14] Gesztesi, Z., Scuderi, P.E., White, P.F., et al. (2000) Substance P (Neurokinin-1) Antagonist Prevents Postoperative Vomiting after Abdominal Hysterectomy Procedures. Anesthesiology, 93, 931-937.
http://dx.doi.org/10.1097/00000542-200010000-00009
[15] Diemunsch, P., Schoeffler, P., Bryssine, B., et al. (1999) Antiemetic Activity of the NK-1 Receptor Antagonist (GR205171) in the Treatment of Established Postoperative Nausea and Vomiting after Major Gynaecological Surgery. British Journal of Anaesthesia, 82, 274-276.
http://dx.doi.org/10.1093/bja/82.2.274
[16] Gan, T.J., Apfel, C.C., Kovac, A., et al. (2007) A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting. Anesthesia & Analgesia, 104, 1082-1089.
http://dx.doi.org/10.1213/01.ane.0000263277.35140.a3
[17] Kakuta, N., Tsutsumi, Y.M., Horikawa, Y.T., et al. (2011) Neurokini-1 Receptor Antagonism, Aprepitant, Effectively Diminishes Post-Operative Nausea and Vomiting While Increasing Analgesic Tolerance in Laparoscopic Gynecologic Procedures. The Journal of Medical Investigation, 58, 246-251.
http://dx.doi.org/10.2152/jmi.58.246
[18] Jung, W.S., Kim, Y.B., Park, H.Y., et al. (2013) Oral Administration of Aprepitant to Prevent Postoperative Nausea in Highly Susceptible Patients after Gynecologic Laparoscopy. Journal of Anesthesia, 27, 396-401.
http://dx.doi.org/10.1007/s00540-012-1529-9
[19] Lee, S.-J., Lee, S.M., Kim, S.I., et al. (2012) 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. Korean Journal of Anesthesiology, 63, 221-226.
http://dx.doi.org/10.4097/kjae.2012.63.3.221

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.