Does esomeprazole prevent post-operative nausea and vomiting?
BACKGROUND
Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post-operative nausea and vomiting (PONV).


METHODS
Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide.


RESULTS
The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0-24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV.


CONCLUSIONS
Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration.
Raeder
J
J
Department of Anaesthesia, Aleris Hospital AS/University of Oslo, Oslo, Norway. johan.rader@medisin.uio.no
Dahl
V
V
Bjoernestad
E
E
Edlund
G
G
Modin
S
S
Naucler
E
E
Bergheim
R
R
Kilhamn
J
J
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000776:Anesthesiology / Q000295:instrumentation; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D064098:Esomeprazole / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D054328:Proton Pump Inhibitors; D012307:Risk Factors
D000932:Antiemetics; D010919:Placebos; D054328:Proton Pump Inhibitors; D064098:Esomeprazole