title: Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study.
abstract: OBJECTIVE
  Postoperative nausea and vomiting (PONV) is the most common postoperative complication. The postoperative use of opioids is known to increase the incidence. We compared fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, and ondansetron for their preventive effects on PONV in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.
  
  
  METHODS
  This prospective, double-blind, randomized study comprised 44 patients who underwent gynecologic abdominal surgery. They were randomly allocated to receive 150 mg intravenous fosaprepitant (n = 24; NKI group) or 4 mg ondansetron (n = 20; ONS group) before anesthesia, which was maintained with volatile anesthetics, remifentanil, fentanyl, and rocuronium. All patients received postoperative fentanyl by patient-controlled epidural anesthesia. The incidence of nausea and vomiting, complete response rate (i.e., no vomiting and no rescue antiemetic use), rescue antiemetic use, nausea score (0-3), and visual analog scale score (VAS 0-10) for pain were recorded at 2, 24, 48, and 72 h after surgery.
  
  
  RESULTS
  No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain.
  
  
  CONCLUSIONS
  Compared to ondansetron, fosaprepitant more effectively decreased the incidence of vomiting in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Tomohiro
authors: T
authors: Soga
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Katsuyoshi
authors: K
authors: Kume
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Nami
authors: N
authors: Kakuta
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Eisuke
authors: E
authors: Hamaguchi
authors: Department of Nutrition, Tokushima University Graduate School, Tokushima, Japan.
authors: Rie
authors: R
authors: Tsutsumi
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Ryosuke
authors: R
authors: Kawanishi
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Kohei
authors: K
authors: Fukuta
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors: Katsuya
authors: K
authors: Tanaka
authors: Department of Anesthesiology, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan. tsutsumi@tokushima-u.ac.jp.
authors: Yasuo M
authors: YM
authors: Tsutsumi
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000732:Androstanols / Q000008:administration & dosage; D000932:Antiemetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D017294:Ondansetron / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011184:Postoperative Period; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium
chemical_list: D000701:Analgesics, Opioid; D000732:Androstanols; D000932:Antiemetics; D009025:Morpholines; D010880:Piperidines; D017294:Ondansetron; C579707:fosaprepitant; D000077208:Remifentanil; D005283:Fentanyl; D000077123:Rocuronium
keywords: Fosaprepitant; Gynecologic abdominal surgery; Ondansetron; Patient-controlled epidural analgesia; Postoperative nausea and vomiting