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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

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Abstract

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.

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Acknowledgments

Supported by JSPS KAKENHI Number 25861378 from Japan Society for the Promotion of Science, Tokyo.

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    Authors and Affiliations

    1. Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan

      Tomohiro Soga, Katsuyoshi Kume, Nami Kakuta, Eisuke Hamaguchi, Ryosuke Kawanishi, Kohei Fukuta, Katsuya Tanaka & Yasuo M. Tsutsumi

    2. Department of Nutrition, Tokushima University Graduate School, Tokushima, Japan

      Rie Tsutsumi

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    1. Tomohiro Soga
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    2. Katsuyoshi Kume
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    3. Nami Kakuta
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    4. Eisuke Hamaguchi
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    6. Ryosuke Kawanishi
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    7. Kohei Fukuta
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    9. Yasuo M. Tsutsumi
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    Correspondence to Yasuo M. Tsutsumi.

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    T. Soga and K. Kume contributed equally to this work.

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    Soga, T., Kume, K., Kakuta, N. et al. 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 . J Anesth 29, 696–701 (2015). https://doi.org/10.1007/s00540-015-2006-z

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    • DOI: https://doi.org/10.1007/s00540-015-2006-z

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