Comparison of the Prophylactic Antiemetic Efficacy of Aprepitant Plus Palonosetron Versus Aprepitant Plus Ramosetron in Patients at High Risk for Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Prospective Randomized-controlled Trial

Abstract

We compared the antiemetic efficacy of aprepitant plus palonosetron versus aprepitant plus ramosetron in patients after laparoscopic cholecystectomy. A total of 88, nonsmoking, female patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups of 44 each who received palonosetron 0.075 mg (aprepitant plus palonosetron group) and ramosetron 0.3 mg (aprepitant plus ramosetron group) after induction of anesthesia. All patients received aprepitant 80 mg 2 hours before surgery. The incidence of postoperative nausea and vomiting (PONV), use of rescue antiemetic, pain severity, and any side effects were assessed for 24 hours after surgery. The incidence of PONV and use of rescue antiemetic were less in aprepitant plus palonosetron group than in aprepitant plus ramosetron group for 24 hours after surgery (P<0.05, respectively). There was no difference in pain severity and side effects including headache and drowsiness. Aprepitant plus palonosetron significantly prevents PONV, compared with aprepitant plus ramosetron in patients at high risk for PONV after laparoscopic cholecystectomy.

NK1 receptor antagonists versus other antiemetics in the prevention of postoperative nausea and vomiting following laparoscopic surgical procedures: a systematic review and meta-analysis

“…Two were excluded as aprepitant was not being compared with other antiemetics in those studies. [ 24 25 ] One was found to be an abstract of another full text article[ 26 ] and hence excluded. Finally, seven articles on aprepitant were included for our systematic review [ Table 1 ].…”

Neurokinin‐1 receptor antagonists for the prevention of postoperative nausea and vomiting

“…Mixed results have been observed in clinical studies of other aprepitant two‐drug combinations for PONV prophylaxis (Table 3). For example, in a randomized, double‐blind study ( N = 88) in high‐risk patients undergoing cholecystectomy, Choi and colleagues observed that oral aprepitant 80 mg 2 h before surgery combined with the 5‐HT3 antagonist palonosetron 0.075 mg intravenously, compared with aprepitant 80 mg combined with the 5‐HT3 antagonist ramosetron 0.3 mg intravenously, significantly reduced the incidence of nausea (but not vomiting) at 0–2 h after surgery (13.6% vs. 36.4%; p = 0.014), 0–24 h after surgery (27.3% vs. 63.6%; p = 0.001), and 2–24 h after surgery (22.7% vs. 54.5%; p = 0.002) 48 . However, in a randomized, single‐blind study ( N = 100), Yoo and colleagues found no significant benefit in the reduction of PONV 24 h following elective surgery with preoperative oral aprepitant 80 mg combined with intravenous palonosetron 0.075 mg versus palonosetron 0.075 mg alone 49 .…”

“…For example, in a randomized, double-blind study (N = 88) in highrisk patients undergoing cholecystectomy, Choi and colleagues observed that oral aprepitant 80 mg 2 h before surgery combined with the 5-HT3 antagonist palonosetron 0.075 mg intravenously, compared with aprepitant 80 mg combined with the 5-HT3 antagonist ramosetron 0.3 mg intravenously, significantly reduced the incidence of nausea (but not vomiting) at 0-2 h after surgery (13.6% vs. 36.4%; p = 0.014), 0-24 h after surgery (27.3% vs. 63.6%; p = 0.001), and 2-24 h after surgery (22.7% vs. 54.5%; p = 0.002). 48 However, in a randomized, single-blind study (N = 100), Yoo and colleagues found no significant benefit in the reduction of PONV 24 h following elective surgery with preoperative oral aprepitant 80 mg combined with intravenous palonosetron 0.075 mg versus palonosetron 0.075 mg alone. 49 In a second randomized study (N = 84) in high-risk patients who had gynecologic surgery, oral aprepitant 80 mg combined with intravenous ramosetron 0.3 mg administered 2-3 h before surgery, compared with ramosetron alone, significantly reduced the incidence of vomiting at 24 h (80.9% vs. 52.4%; p < 0.05) and the use of rescue antiemetics.…”