A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone

Abstract

Background. Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG. Methods. Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0–2 h (early) and 2–24 h (late). The primary outcome was the complete response 0‐24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes. Results. The A/D and M/D groups were superior to the D group for a complete response within 0–24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0–24 h after surgery ( P < 0.001 , P < 0.001 , respectively). The peak nausea scores (2–24 h) were significantly reduced in the M/D group in comparison to the D group ( P = 0.005 ). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2–24 h) and less analgesic requirements ( P < 0.001 , P < 0.001 , P < 0.001 , respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score ( P < 0.001 ). Conclusion. Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.

The Impact of Preoperative Dexamethasone Administration on Quality of Recovery Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study

“…LSG is associated with PONV, which not only affects patient comfort, but can also lead to delayed discharge from the post-anesthesia care unit [ 23 ]. Dexamethasone has been approved as a standard prophylactic and therapeutic agent for PONV [ 4 ].…”

Sub-hypnotic dose of midazolam is effective in reducing intraoperative nausea and vomiting during cesarean sections under spinal anesthesia

“…21 Previously some meta-analyses suggested that combination of dexamethasone with a 5-HT 3 receptor antagonist resulted in high antiemetic efficacy, and this combination was determined as the 'optimal' choice for prophylaxis against N/V. 22,23 However, some other authors concluded that an addition of dolasetron or ondansetron failed to improve the anti-emetic efficacy of dexamethasone when they were used for routine prophylaxis to prevention of N/V. 24,25 In the absence of any consensus, it is prudent to explore more options and more therapeutic measures.…”

Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial

“…Aprepitant is a highly selective neurokinin-1 (NK1) receptor and substance P antagonist. It is commonly used to prevent nausea and vomiting in patients undergoing chemotherapy, as well as to prevent opioid-induced emesis [ 6 , 7 ]. With a half-life of 9-12 h, aprepitant is highly effective in preventing both acute and delayed emesis [ 8 ].…”