Aprepitant in combination with palonosetron for the prevention of postoperative nausea and vomiting in female patients using intravenous patient-controlled analgesia

Abstract

BackgroundThe aim of this study was to evaluate aprepitant in combination with palonosetron as compared to palonosetron alone for the prevention of postoperative nausea and vomiting (PONV) in female patients receiving fentanyl- based intravenous patient-controlled analgesia (IV-PCA).MethodsIn this randomized single-blinded study, 100 female patients scheduled for elective surgery under general anesthesia were randomized to two groups: Group AP (80 mg aprepitant plus 0.075 mg palonosetron, n = 50) and Group P (0.075 mg palonosetron, n = 50). The patients in group AP received 80 mg aprepitant per oral 1–3 h before surgery, while all patients received 0.075 mg palonosetron after induction of standardized anesthesia. All patients had postoperative access to fentanyl-based IV-PCA. The incidence of nausea and vomiting, use of rescue medication, and severity of nausea were evaluated at 6 and 24 h after surgery.ResultsThe incidence of nausea (54%) and vomiting (2%) in group AP did not differ significantly from that in group P (48% and 14%, respectively) during the first 24 h after surgery (P > 0.05). Patient requirements for rescue medication in group AP (29%) were similar to those in group P (32%) at 24 h after surgery (P > 0.05). There was no difference between the groups in severity of nausea during the first 24 h after surgery (P > 0.05).ConclusionsAprepitant combined with palonosetron did not reduce the incidence of PONV as compared to palonosetron alone within 24 h of surgery in women receiving fentanyl-based IV-PCA.

Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial

“…In contrast, in a previous study we reported a reduced incidence of PONV with the combination of ondansetron and aprepitant in patients undergoing laparoscopic surgery ( 15 ). Although we did not find a beneficial effect on the association of palonosetron and aprepitant in the present work, the incidence of PONV was lower than that reported in other studies ( 16 ), with a very low incidence of vomiting, similar to Yoo et al ( 17 ).…”

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“…The NK-1 receptor antagonist aprepitant appears to be more effective in decreasing PONV as compared with ondansetron 189 , 190 . Aprepitant alone or in combination was associated with a low overall incidence of PONV 191 , 192 in patients undergoing laparoscopic surgery 193 , craniotomy 194 , mastectomy and thyroidectomy 195 , and elective surgery 196 and in pediatric patients 197 . Because of its high cost, aprepitant should be used only in patients at high risk of developing PONV and in those who could experience serious adverse outcomes due to PONV as well as in patients who may have side effects from less-expensive antiemetic drugs 191 , 192 .…”

Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

“…On the other hand, Yoo et al 69 conducted a clinical trial of 100 moderate risk female patients undergoing moderate-to-high risk surgeries, and reported that aprepitant plus palonosetron did not significantly reduce the incidence of PONV or the rescue anti-emetic requirement when compared to palonosetron alone. One possible explanation is that, as palonosetron is intrinsically more effective than the other 5-HT 3 antagonists, the marginal gain of adding aprepitant is diminished.…”