Effect of combinations of dexamethasone-ondansetron and dexamethasone-ondansetron-aprepitant versus aprepitant alone for early postoperative nausea and vomiting after day care gynaecological laparoscopy

Abstract

Background and Aims: This study was designed to compare the effectiveness of the combination of dexamethasone–ondansetron with oral aprepitant alone and triple combination therapy with all three agents (dexamethasone-ondansetron and oral aprepitant) in the prevention of postoperative nausea and vomiting (PONV) in day care gynaecologic laparoscopy. Methods: This was a randomised clinical trial conducted at a university teaching hospital. A total of 105 female patients were randomised into the aprepitant (A), dexamethasone-ondansetron (DO) and aprepitant-dexamethasone-ondansetron (ADO) groups. The patients in the A group received only 80 mg oral aprepitant 1 h before surgery. The patients in the DO group, received dexamethasone 8 mg at induction with ondansetron 4 mg before extubation. Patients in the ADO group received 80 mg oral aprepitant 1 h before surgery, dexamethasone 8 mg at induction and ondansetron 4 mg before extubation. Incidence of nausea and vomiting was compared between groups using the Chi-square test/Fisher's test. Bellville score for severity of PONV was analysed using the Kruskall-Wallis test. P value < 0.05 was regarded as significant. Results: The incidence of PONV did not show a statistically significant difference between the three groups, with a P value of 0.13 (12.5%, 30.3% and 32.3% in groups ADO, DO and A, respectively). The severity of PONV measured using Bellville score was also not significantly different among the groups [median values (IQR) of 0 (0-0), 0 (0-1), and 0 (0-1)]. Conclusion: The combination of aprepitant, dexamethasone and ondansetron failed to demonstrate a statistically significant superiority over the other two antiemetic regimens.

The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis

“…Seven studies reported the incidence of vomiting. [9,12–14,18,23,24] A significant advantage was detected in the group treated with aprepitant (OR: 0.20, 95% CI: 0.08, 0.50, P = .0005) (Fig. 3C).…”

“…Furthermore, pooled data from 3 studies that analyzed dexamethasone and ondansetron combined with aprepitant [14,15,18] showed that the incidence of PONV in dexamethasone and ondansetron combined with aprepitant groups was significantly lower than that of control groups given dexamethasone combined with ondansetron (OR: 0.36, 95% CI: 0.16, 0.82, P < .05) (Fig. 3B).…”

“…All operations were performed under general anesthesia (including 5 studies that used fentanyl for postoperative patient-controlled analgesia). The following different doses of aprepitant were used in 17 trials: 40 mg, [22,25,[27][28][29] 80 mg, [9,[12][13][14][15][18][19][20][21]23,26] and 125 mg. [20,21,23,[27][28][29] In the intervention group, a precipitant was primarily or adjunctively used as an emetic agent. In the control group, ondansetron, dexamethasone, palonosetron, ramosetron, or placebo was administered alone or in combination.…”

“…Use of a rescue antiemetic. An assessment of 12 studies that assessed the use of a rescue antiemetic [9,[12][13][14]18,20,21,[24][25][26][27][28][29] showed no significant inter-group differences (OR: 0.86; 95% CI: 0.68,1. 09; P = .21) (Figure S1E, Supplemental Digital Content, http://links.lww.com/MD/J322).…”

“…Adverse events with aprepitant Thanuja [18] 2021 India RCT Day care gynecologic laparoscopy VICA 80 mg Dex, Ondan, Apre Dex, Ondan Pain, agitation, and lethargy (2 groups did not differ significantly) Grigio [14] 2020 Brazil Double-blinded RCT Unilateral mastectomy TIVA 80 mg Dex, Palono, Apre Dex,Palono N/A Spaniolas [15] 2020 US RCT Sleeve gastrectomy TIVA 80 mg Dex, Ondan, Apre Dex, Ondan N/A Yoo [12] 2018 Korea Single-blinded RCT Elective surgery (Major orthopedic operation)…”