Postoperative Nausea and Vomiting (PONV)

Postoperative nausea and vomiting (PONV) commonly occurs within 24 hours after surgery, especially in the post-anaesthesia care unit, and affects nearly 30% of patients worldwide. A recent study conducted a systematic review and meta-analysis to compare the effectiveness of aprepitant alone, aprepitant plus ondansetron, and aprepitant plus dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) compared to ondansetron alone or combined with dexamethasone. The analysis reviewed 12 studies involving 2729 patients and found that aprepitant alone significantly reduced PONV compared to ondansetron alone, with a PONV incidence of 12.5% vs. 28.5%, and a higher complete response rate. The combination of aprepitant with ondansetron also showed a significantly lower PONV incidence and a higher complete response rate compared to ondansetron alone. Additionally, aprepitant combined with dexamethasone and ondansetron significantly reduced PONV incidence compared to dexamethasone and ondansetron alone.

Conclusion and Limitations

The study concluded that aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response and reducing the need for rescue therapy during the postoperative period. The systematic review integrated data from various trials and demonstrated the versatility and reliability of aprepitant as a prophylactic antiemetic across diverse surgical contexts and timeframes. The study highlighted the importance of multimodal antiemetic approaches and the potential synergistic effects of combining aprepitant with other drugs for PONV prevention. However, the study acknowledged various limitations, such as heterogeneity among included studies, potential publication bias, and variability in aprepitant dosages and administration routes, which may have influenced the observed efficacy.

Implications and Further Research

Overall, the findings emphasized the strong and consistent antiemetic efficacy of aprepitant and suggested the need for continued research to elucidate the true effectiveness of interventions across various postoperative outcomes, thereby informing clinical practice with precision and confidence. The study underscored the critical role of aprepitant in enhancing the overall postoperative experience for patients and emphasized the need for future research to address existing knowledge gaps and improve antiemetic strategies.

Key Points

• A systematic review and meta-analysis compared the effectiveness of aprepitant alone, aprepitant plus ondansetron, and aprepitant plus dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) compared to ondansetron alone or combined with dexamethasone.
• A total of 12 studies involving 2729 patients were reviewed. Aprepitant alone significantly reduced PONV compared to ondansetron alone, with a PONV incidence of 12.5% vs. 28.5%, and a higher complete response rate. The combination of aprepitant with ondansetron also showed a significantly lower PONV incidence and a higher complete response rate compared to ondansetron alone.
• Aprepitant combined with dexamethasone and ondansetron significantly reduced PONV incidence compared to dexamethasone and ondansetron alone.
• The study concluded that aprepitant consistently outperforms ondansetron in achieving a complete response and reducing the need for rescue therapy during the postoperative period, regardless of whether used alone or in combination with ondansetron or both ondansetron and dexamethasone.
• However, the study acknowledged various limitations, such as heterogeneity among included studies, potential publication bias, and variability in aprepitant dosages and administration routes, which may have influenced the observed efficacy.
• The findings emphasized the strong and consistent antiemetic efficacy of aprepitant and suggested the need for continued research to elucidate the true effectiveness of interventions across various postoperative outcomes, thereby informing clinical practice with precision and confidence. The study also highlighted the critical role of aprepitant in improving the overall postoperative experience for patients and called for future research to address existing knowledge gaps and improve antiemetic strategies.

Reference

Singh MP, Gurunthalingam MP, Gupta A, Singh J. Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta‑analysis with trial sequential analysis. Indian J Anaesth 2024;68:762‑75