title: Aprepitant's prophylactic efficacy in decreasing postoperative nausea and vomiting in morbidly obese patients undergoing bariatric surgery.
abstract: BACKGROUND
  Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.
  
  
  METHODS
  After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.
  
  
  RESULTS
  Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3%) compared to group P (15%; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan-Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67%). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.
  
  
  CONCLUSIONS
  In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.
authors.affiliation: Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA, Ashish.Sinha@drexelmed.edu.
authors.forename: Ashish C
authors.initials: AC
authors.lastname: Sinha
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
authors.forename: Noel W
authors.initials: NW
authors.lastname: Williams
authors.forename: Edward Andrew
authors.initials: EA
authors.lastname: Ochroch
authors.forename: Basavana G
authors.initials: BG
authors.lastname: Goudra
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D050110:Bariatric Surgery / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D009767:Obesity, Morbid / Q000601:surgery*; D017294:Ondansetron / Q000627:therapeutic use*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant; D017294:Ondansetron