Effect of the Dexamethasone-Ondansetron Combination Versus Dexamethasone-Aprepitant Combination to Prevent Postoperative Nausea and Vomiting

Bilgen, Semih; Kızılcık, Nurcan; Haliloğlu, Murat; Yıldırım, Gazi; Kaspar, Elif Çiğdem; Köner, Özge

doi:10.5152/tjar.2018.53179

Cited by 11 publications

(18 citation statements)

References 30 publications

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“…Also Habib et al, (30) found that the combination of oral aprepitant 40 mg and dexamethasone 10 mg IV was more effective than the combination of ondansetron and dexamethasone for prophylaxis against postoperative vomiting in adult patients undergoing craniotomy under general anesthesia. Furthermore, in contrast to our study, the study designed by Bilgen et al, (31) reported that dexamethasone 8 mg IV/oral aprepitant 40 mg did not improve the complete response for PONV compared to dexamethasone 8 mg IV/ondansetron 4 mg IV in patients undergoing laparoscopic surgery.…”

Section: Discussioncontrasting

confidence: 99%

“…The combination of dexamethasone with a 5-HT 3 receptor antagonist was recommended for high-risk patients (30,31) . Concomitant with our results, Chen et al, (20) evaluated the effect of premedication with oral mirtazapine 30 mg plus dexamethasone 8 mg versus dexamethasone 8 mg alone in 80 moderate and high-risk female patients undergoing gynecological surgery under general anesthesia and found that the combination of mirtazapine plus dexamethasone effectively reduced the level of preoperative anxiety and the incidence of late PONV.…”

Section: Discussionmentioning

confidence: 99%

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Effects of aprepitant /dexamethasone versus mirtazapine/dexamethasone on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial

Ashoor¹,

Kassim²,

Hasseb³

et al. 2020

Preprint

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Background Co-administration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) following laparoscopic sleeve gastrectomy (LSG). The investigators compared the combination of aprepitant and dexamethasone (A/D) with the combination of mirtazapine and dexamethasone (M/D) for prevention of PONV in morbidly obese patients undergoing LSG. Methods Ninety patients scheduled for LSG were assigned to receive a single preoperative dose of dexamethasone 8 mg IVI (D group), and in addition to oral aprepitant 80 mg (A/D group) or oral mirtazapine 30 mg (M/D group) in a randomized, double-blind trial. Assessment of PONV was done 0–2 h (early) and 2–24 hours (late). Patients’ level of sedation, satisfaction and postoperative pain were also assessed. Results A/D and M/D groups were superior to D group for complete response 0–24 h after surgery (79.3% for A/D group, 78.6% for M/D group and 20.7% for D group). D group was inferior to A/D and M/D groups regarding collective PONV and use of rescue antiemetics (P < 0.001) 0–24 h after surgery. The peak nausea scores 2–24 h were significantly lower in both A/D and M/D groups vs. D group (P = 0.005). Patients in the M/D group showed higher sedation scores while those in A/D groups showed lower pain scores and less analgesic requirements. A/D and M/D groups were superior to D group regarding the patient’s satisfaction score. Conclusion A/D and M/D combinations were superior to D alone regarding the proportion of patients exhibiting a complete response in preventing PONV associated with LSG. Trial Registration: Clinical Trials. gov Identifier: NCT04013386/ prospectively registered: 09/07/2019, http://www.Clinical Trial.gov

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of aprepitant /dexamethasone versus mirtazapine/dexamethasone on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial

Ashoor¹,

Kassim²,

Hasseb³

et al. 2020

Preprint

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“…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 .…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

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

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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“…Habib et al 70 conducted a clinical trial of 104 low-to-moderate risk patients undergoing craniotomy, and reported that aprepitant plus dexamethasone significantly reduced the incidence of PONV compared to ondansetron plus dexamethasone. On the other hand, Bilgen et al 71 conducted a clinical trial of 67 moderate-to-high risk patients undergoing laparoscopic surgeries, and reported that aprepitant plus dexamethasone did not significantly reduce the incidence of PONV or the rescue anti-emetic requirement when compared to ondansetron and dexamethasone.…”

Section: Novel Chemoprophylaxismentioning

confidence: 99%

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

Jin¹,

Gan²,

Bergese³

2020

TCRM

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Postoperative nausea and vomiting is one of the most frequent adverse events after surgery and anesthesia. It is distressing for the patient and can lead to other postoperative complications. Management of PONV involves a framework of risk assessment, multimodal risk reduction, and prophylactic measures, as well as prompt rescue treatment. There has been a significant paradigm shift in the approach towards PONV prevention. There have also been several emerging therapeutic options for PONV prophylaxis and treatment. In this review, we will discuss the up-to-date PONV management guidelines and highlight novel therapeutic options which have emerged in the last few years.

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Effect of the Dexamethasone-Ondansetron Combination Versus Dexamethasone-Aprepitant Combination to Prevent Postoperative Nausea and Vomiting

Abstract: the manuscript, references should be cited using Arabic numbers in parentheses. The reference styles for different types of publications are presented in the following examples.

Cited by 11 publications

References 30 publications

Effects of aprepitant /dexamethasone versus mirtazapine/dexamethasone on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial

Effects of aprepitant /dexamethasone versus mirtazapine/dexamethasone on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial

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

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

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