title: A Prospective, Randomized, Double-Blinded, Double-Dummy Pilot Study to Assess the Preemptive Effect of Triple Therapy with Aprepitant, Dexamethasone, and Promethazine versus Ondansetron, Dexamethasone and Promethazine on Reducing the Incidence of Postoperative Nausea and Vomiting Experienced by Patients Undergoing Craniotomy Under General Anesthesia.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) is among the most common distressing complications of surgery under anesthesia. Previous studies have demonstrated that patients who undergo craniotomy have incidences of nausea and vomiting as high as 50-70%. The main purpose of this pilot study is to assess the incidence of PONV by using two different prophylactic regimens in subjects undergoing a craniotomy. Thus, we designed this study to assess the efficacy and safety of triple therapy with the combination of dexamethasone, promethazine, and aprepitant versus ondansetron to reduce the incidence of PONV in patients undergoing craniotomy.
  
  
  METHODS
  This is a prospective, single center, two-armed, randomized, double-dummy, double-blind, pilot study. Subjects were randomly assigned to one of the two treatment groups. Subjects received 40 mg of aprepitant pill (or matching placebo pill) 30-60 min before induction of anesthesia and 4 mg of ondansetron IV (or 2 ml of placebo saline solution) at induction of anesthesia. In addition, all subjects received 25 mg of promethazine IV and 10 mg of dexamethasone IV at induction of anesthesia. Assessments of PONV commenced for the first 24 h after surgery and were subsequently assessed for up to 5 days.
  
  
  RESULTS
  The overall incidence of PONV during the first 24 h after surgery was 31.0% (n = 15) in the aprepitant group and 36.2% (n = 17) for the ondansetron group. The median times to first emetic and significant nausea episodes were 7.6 (2.9, 48.7) and 14.3 (4.4, 30.7) hours, respectively, for the aprepitant group and 6.0 (2.2, 29.5) and 9.6 (0.7, 35.2) hours, respectively, for the ondansetron group. There were no statistically significant differences between these groups. No adverse events directly related to study medications were found.
  
  
  CONCLUSIONS
  This pilot study showed similar effectiveness when comparing the two PONV prophylaxis regimens. Our data showed that both treatments could be effective regimens to prevent PONV in patients undergoing craniotomy under general anesthesia. Future trials testing new PONV prophylaxis regimens in this surgical population should be performed to gain a better understanding of how to best provide prophylactic treatment.
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Sergio Daniel
authors.initials: SD
authors.lastname: Bergese
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Erika G
authors.initials: EG
authors.lastname: Puente
authors.affiliation: Department of Anesthesiology, Jackson Memorial Hospital, University of Miami , Miami, FL , USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Antor
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Adolfo L
authors.initials: AL
authors.lastname: Viloria
authors.affiliation: Center for Biostatistics, The Ohio State University , Columbus, OH , USA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Yildiz
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Nicolas Alexander
authors.initials: NA
authors.lastname: Kumar
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Uribe
keywords: PONV; aprepitant; craniotomy; nausea; ondansetron; triple therapy; vomiting