Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial

Hyoung Yong Moon, Chong Wha Baek, Geun Joo Choi, Hwa Yong Shin, Hyun Kang, Yong Hun Jung, Young Cheol Woo, Jin Yun Kim, Seul Gi Park, Hyoung Yong Moon, Chong Wha Baek, Geun Joo Choi, Hwa Yong Shin, Hyun Kang, Yong Hun Jung, Young Cheol Woo, Jin Yun Kim, Seul Gi Park

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Palonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared palonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery.

Methods: Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual analogue scale [VAS] nausea score <4 and no use of rescue therapy) 0-48 h after surgery. Nausea severity (0-10) and use of rescue therapy were monitored for 0-48 h. The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and use of rescue analgesics.

Results: Aprepitant was non-inferior to palonosetron in terms of complete response 0-48 hours after surgery (74% vs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were required in the aprepitant group.

Conclusions: Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they bind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management in humans.

Keywords: Aprepitant; Gynaecologic; Laparoscopic; PONV; Palonosetron.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Severity of nausea over 48 postoperative hours, graded using a 10-point visual analogue scale (VAS), in the female patients who underwent laparoscopic gynaecologic surgery. The data are expressed as mean ± standard error values of the mean. *P < 0.05, compared with group P. Group P was given 0.075 mg of palonosetron intravenously, whereas group A was given 40 mg of oral aprepitant.
Figure 3
Figure 3
Severity of pain over 48 postoperative hours in the female patients who underwent laparoscopic gynaecologic surgery, graded using a 10-point visual analogue scale (VAS). The data are expressed as mean ± standard error values of the mean. Group P was given 0.075 mg of palonosetron intravenously, whereas group A was given 40 mg of oral aprepitant.
Figure 4
Figure 4
Fentanyl consumption over 48 postoperative hours in the female patients who underwent laparoscopic gynaecologic surgery. The graph shows the changes in fentanyl consumption according to the type of drug administered. The data are expressed as mean ± standard error values of the mean. *P < 0.05, compared with the palonosetron group. Group P was given 0.075 mg of palonosetron intravenously, whereas group A was given 40 mg of oral aprepitant.

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