title: Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Palonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared palonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery.
  
  
  METHODS
  Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual analogue scale [VAS] nausea score <4 and no use of rescue therapy) 0-48 h after surgery. Nausea severity (0-10) and use of rescue therapy were monitored for 0-48 h. The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and use of rescue analgesics.
  
  
  RESULTS
  Aprepitant was non-inferior to palonosetron in terms of complete response 0-48 hours after surgery (74% vs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were required in the aprepitant group.
  
  
  CONCLUSIONS
  Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they bind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management in humans.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Hyoung Yong
authors.initials: HY
authors.lastname: Moon
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Chong Wha
authors.initials: CW
authors.lastname: Baek
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Geun Joo
authors.initials: GJ
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Hwa Yong
authors.initials: HY
authors.lastname: Shin
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Young Cheol
authors.initials: YC
authors.lastname: Woo
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Jin Yun
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Seul Gi
authors.initials: SG
authors.lastname: Park
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D000077924:Palonosetron; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011812:Quinuclidines / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D007546:Isoquinolines; D009025:Morpholines; D011812:Quinuclidines; D000077608:Aprepitant; D000077924:Palonosetron
keywords: Aprepitant; Gynaecologic; Laparoscopic; PONV; Palonosetron