title: Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures.
abstract: OBJECTIVE
  Post-operative nausea and vomiting (PONV) remains the most frequently reported patient complaint after anesthesia. Aprepitant is the first neurokinin-1(NK1) receptor antagonism available for use as an antiemetic. We investigated whether aprepitant can effectively decrease PONV in patients undergoing laparoscopic gynecological surgery.
  
  
  METHODS
  Sixty four patients receiving general anesthesia for laparoscopic gynecological surgery were randomly assigned to either receive a preoperative dose of 80 mg aprepitant or no drug. Efficacy was assessed in 2 and 24 hours after surgery. Primary and secondary endpoints were analyzed for the time intervals 0-2 hours (acute phase) and 2-24 hours (delayed phase). Vomiting, nausea, use of rescue anti-emetic, and visual analog scale (VAS) were assessed. Nausea was assessed on a 4-point scale, from 0 to 3.
  
  
  RESULTS
  Sixty patients participated in the study. At acute phase, PONV was present in both control and NK1 group and were 63% and 43% respectively. The severity of nausea was much less in the NK1 group. PONV prevalence at delayed phase was present in control but absent in NK1 group 27% vs. 0%, respectively. The amount of pain medication used by patients in the NK1 group was significantly less for diclofenac and pentazocine suggesting increase pain tolerance.
  
  
  CONCLUSIONS
  Neurokinin-1 receptor antagonism effectively lowered PONV increased pain tolerance, and expedited recovery in patients undergoing laparoscopic gynecological surgery.
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Nami
authors.initials: N
authors.lastname: Kakuta
authors.forename: Yasuo M
authors.initials: YM
authors.lastname: Tsutsumi
authors.forename: Yousuke T
authors.initials: YT
authors.lastname: Horikawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawano
authors.forename: Michiko
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Shuzo
authors.initials: S
authors.lastname: Oshita
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D064729:Neurokinin-1 Receptor Antagonists; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D009025:Morpholines; D064729:Neurokinin-1 Receptor Antagonists; D000077608:Aprepitant