The Effects of Intravenous Fosaprepitant and Ondansetron for the Prevention of Postoperative Nausea and Vomiting in Neurosurgery Patients: A Prospective, Randomized, Double-Blinded Study

Abstract

The incidence of postoperative nausea and vomiting (PONV) is 30–50% after surgery. PONV occurs frequently, especially after craniotomy. In this study, we investigated the preventive effects on PONV in a randomized study by comparing patients who had been administered fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, or ondansetron intravenously. Sixty-four patients undergoing craniotomy were randomly allocated to receive fosaprepitant 150 mg i.v. (NK1 group, n = 32) or ondansetron 4 mg i.v. (ONS group, n = 32) before anesthesia. The incidence of vomiting was significantly less in the NK1 group, where 2 of 32 (6%) patients experienced vomiting compared to 16 of 32 (50%) patients in the ONS group during the first 24 and 48 hours following surgery. Additionally, the incidence of complete response (no vomiting and no rescue antiemetic use) was significantly higher in the NK1 group than in the ONS group, and was 66% versus 41%, respectively, during the first 24 hours, and 63% versus 38%, respectively, during the first 48 hours. In patients undergoing craniotomy, fosaprepitant is more effective than ondansetron in increasing the rate of complete response and decreasing the incidence of vomiting at 24 and 48 hours postoperatively.

The effects of intravenous fosaprepitant and ondansetron in the prevention of postoperative nausea and vomiting in patients who underwent lower limb surgery: a prospective, randomized, double-blind study

“…We determined the precise sample size for this trial based on our previous study that compared the preventive effects on PONV of fosaprepitant with that of ondansetron in neurosurgery patients [13]. The study demonstrated that the vomiting rate in the NK1 group was 6 % of 32 patients, while that in the ONS group was 50 % of 32 patients.…”

“…Recently, we reported that fosaprepitant was more effective in decreasing the incidence of vomiting after neurosurgery [13] and gynecologic surgery [14]. On the basis of these Abstract Purpose Postoperative nausea and vomiting (PONV) is the most common complication after surgery, and opioid administration increases its incidence.…”

Anti-emetic Drugs for Prophylaxis of Postoperative Nausea and Vomiting After Craniotomy: An Updated Systematic Review and Network Meta-Analysis

“…After examining titles and abstracts, 86 potentially relevant articles were identified, and a full-text review of each article was performed (see Appendix for a comprehensive list of these studies). A final number of 17 trials with a total of 1,433 participants were enrolled in this NMA (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) (Figure 1). Fifteen trials assessed PON, whereas all 17 trails assessed POV.…”

“…Female participants accounted for 52% of patients, with age ranging between 32 and 63 years. Three studies reported no intraoperative or postoperative dexamethasone use (21,22,24). The AED investigated included 5-hydroxytryptamine (5-HT3) receptor antagonists (granisetron, ondansetron, ramosetron, and tropisetron), neurokinin-1 (NK-1) receptor antagonists (fosaprepitant, aprepitant), butyrophenones (droperidol), corticosteroids (dexamethasone), phenothiazines (metoclopramide), and other unclassified drugs (gabapentin).…”

Postoperative nausea and vomiting following lower limb surgery :a comparison between single-injection intraarticular anesthesia and continuous epidural anesthesia

“…PONV is considered by many patients to be more distressing than postoperative pain (2). The general incidence of PONV is approximately 50% and in a subset of high-risk patients, PONV rates can be as high as 70% (3,4,5,6). The four main risk factors of PONV include the female sex, a history of PONV or motion sickness, being a nonsmoker, and the use of postoperative opioids (7).…”