Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study.
PURPOSE
Postoperative nausea and vomiting (PONV) is the most common postoperative complication. The postoperative use of opioids is known to increase the incidence. We compared fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, and ondansetron for their preventive effects on PONV in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.


METHODS
This prospective, double-blind, randomized study comprised 44 patients who underwent gynecologic abdominal surgery. They were randomly allocated to receive 150 mg intravenous fosaprepitant (n = 24; NKI group) or 4 mg ondansetron (n = 20; ONS group) before anesthesia, which was maintained with volatile anesthetics, remifentanil, fentanyl, and rocuronium. All patients received postoperative fentanyl by patient-controlled epidural anesthesia. The incidence of nausea and vomiting, complete response rate (i.e., no vomiting and no rescue antiemetic use), rescue antiemetic use, nausea score (0-3), and visual analog scale score (VAS 0-10) for pain were recorded at 2, 24, 48, and 72 h after surgery.


RESULTS
No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain.


CONCLUSION
Compared to ondansetron, fosaprepitant more effectively decreased the incidence of vomiting in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.
['Soga|Tomohiro|T|', 'Kume|Katsuyoshi|K|', 'Kakuta|Nami|N|', 'Hamaguchi|Eisuke|E|', 'Tsutsumi|Rie|R|', 'Kawanishi|Ryosuke|R|', 'Fukuta|Kohei|K|', 'Tanaka|Katsuya|K|', 'Tsutsumi|Yasuo M|YM|']
D000328:Adult D015360:Analgesia, Epidural D016058:Analgesia, Patient-Controlled D000701:Analgesics, Opioid D000732:Androstanols D000932:Antiemetics D004311:Double-Blind Method D005260:Female D005283:Fentanyl D013509:Gynecologic Surgical Procedures D006801:Humans D008875:Middle Aged D009025:Morpholines D017294:Ondansetron D010146:Pain D010880:Piperidines D020250:Postoperative Nausea and Vomiting D011184:Postoperative Period D011446:Prospective Studies D000077208:Remifentanil D000077123:Rocuronium
Fosaprepitant Ondansetron Postoperative nausea and vomiting Gynecologic abdominal surgery Patient-controlled epidural analgesia