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

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature. Methods: To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured. Results: Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: −1.09; 95% CI: −6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators. Conclusion: Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration.

Náusea e vômito pós-operatórios: Revisão de literatura

“…Ainda existem outros antagonistas do receptor NK1, porém não foram liberados para uso na NVPO ou não apresentam tanta eficácia. (Liu et al, 2023) Os antagonistas do receptor H1 da histamina têm uma eficácia particular no tratamento de náuseas e vómitos precipitados pelas vias vestibulares, com benefício documentado no tratamento do enjoo de procedimentos cirúrgicos para estrabismo ou envolvendo o ouvido médio. Anti-histamínicos como dimenidrinato e difenidramina possuem eficácia antiemética semelhante à relatada para dexametasona, droperidol e antagonistas 5-HT3.…”

Efficacy of Antiemetic Drugs in Preventing Nausea and Vomiting in Patients Undergoing General Anesthesia: A Systematic Review

“…It is a frequent postoperative complication with debilitating impacts, such as excruciating pain that lowers patient satisfaction and extends patient's stay at the hospital. 1 The severe effects associated with the PONV lead to unplanned readmissions that place a significant financial burden on the family members. In addition to these negative effects, Unsal et al posited that PONV may result in other problems, including higher medication costs, severe bleeding, aspiration pneumonia and electrolyte imbalance.…”

Comparative Evaluation of Oral Aprepitant vs. Injection Palonosetron for Preventing Post-operative Nausea and Vomiting in Laparoscopic Cholecystectomy Patients under General Anaesthesia: A Randomized Trial

“…Another study demonstrated the superior effectiveness of Palonosetron over Ondansetron in the prevention of PONV, with similar incidences of adverse effects [9]. Additionally, a meta-analysis on the efficacy of Aprepitant for PONV prevention highlighted its significant role in reducing the occurrence of PONV, although its effects on postoperative analgesia require further exploration [10].…”