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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 9/2010

01-09-2010 | Symposium: Complications of Hip Arthroplasty

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Authors: Timothy M. DiIorio, BS, Peter F. Sharkey, MD, Agnes M. Hewitt, MD, Javad Parvizi, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2010

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Abstract

Background

Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics.

Questions/purposes

We asked whether a single dose of preoperative aprepitant (40 mg orally) reduced postoperative nausea and vomiting after THA or TKA.

Methods

Fifty patients who received a preoperative dose of aprepitant (study group) were matched demographically to 50 patients who did not receive aprepitant (control group) from a group of patients undergoing THA or TKA. Patients’ charts were reviewed to identify episodes of PONV, number of doses of antiemetics needed for breakthrough PONV, and length of stay. Aprepitant side effects, and complications.

Results

Aprepitant reduced the percentage of patients with PONV (39% of study and 70% of control patients). Moderate or severe PONV occurred in 22% of study and 40% of control patients. The number of episodes of PONV during hospitalization was 2.9 for the control group and 1.6 for the study group. Postoperatively, the control group required on average 1.3 doses of ondansetron compared with 0.6 doses for the study group. Hospital length of stay was reduced from 3.3 days for the control group and to 2.3 days for the study group.

Conclusions

These data suggest a single preoperative dose of aprepitant reduces the number of episodes and severity of PONV, the need for additional antiemetics, and the length of stay.

Level of Evidence

Level II, prognostic study. See guidelines for authors for a complete description of levels of evidence.
Literature
1.
Adam F, Chauvin M, Du Manoir B, Langlois M, Sessler DI, Fletcher D. Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg. 2005;100:475–480.CrossRefPubMed
2.
Alon E, Himmelseher S. Ondansetron in the treatment of postoperative vomiting: a randomized, double-blind comparison with droperidol and metroclopramide. Anesth Analg. 1992;75:561–565.CrossRefPubMed
3.
Bengtsson M, Lofstrom JB, Merts H. Postoperative pain relief with intrathecal morphine after major hip surgery. Reg Anesth. 1983;8:140–143.
4.
Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Papropsky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. 2004;429:239–247.CrossRefPubMed
5.
Brodner G, Scherer R, Van Aken H. Continuous spinal anesthesia or continuous epidural anesthesia for postoperative pain control after hip replacement. Eur J Anesthesiol. 2000;17:402–403.
6.
Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am. 2006;88:959–963.CrossRefPubMed
7.
Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15.CrossRefPubMed
8.
Chen JJ, Frame DG, White TJ. Efficacy of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting after total hip replacement or total knee replacement: a randomized, double-blinded, comparative trial. Arch Intern Med. 1998;158:2124–2128.CrossRefPubMed
9.
Cole PJ, Craske DA, Wheatley RG. Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroplasty. Br J Anaesth. 2000;85:233–237.CrossRefPubMed
10.
Cousins MJ, Mater LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61:276–310.CrossRefPubMed
11.
Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res. 2007;463:7–12.PubMed
12.
Du Pen S, Scuderi P, Wetchler B, Sung YF, Mingus M, Clayborn L, Leslie J, Talke P, Apfelbaum J, Sharifi-Azad S, et al. Ondansetron in the treatment of postoperative nausea and vomiting in ambulatory outpatients: a dose-comparative, stratified, multicenter study. Eur J Anaesthesiol Suppl. 1992;6:55–62.PubMed
13.
Fujii Y, Tanaka H. Prevention of nausea and vomiting with ramosetron after total hip replacement. Clin Drug Invest. 2003;23:405–409.CrossRef
14.
Gan TJ, Alexander R, Fennelly M, Rubin AP. Comparison of different methods of administering droperidol in patient-controlled analgesia in the prevention of postoperative nausea and vomiting. Anesth Analg. 1995;80:81–85.CrossRefPubMed
15.
Gan TJ, Collis R, Hetreed M. Double-blind comparison of ondansetron, droperidol and saline in the prevention of postoperative nausea and vomiting. Br J Anaesth. 1994;72:544–547.CrossRefPubMed
16.
Gan TJ, Ginsberg B, Grant AP, Glass PS. Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology. 1996;85:1036–1042.CrossRefPubMed
17.
Grattidge P. Nausea and vomiting after major arthroplasty with spinal anesthesia including morphine: a randomized trial of subhypnotic protocol infusion as prophylaxis. Acta Anaesthesiol Scand. 1998;42:124–127.CrossRefPubMed
18.
Inaba Y, Dorr LD, Wan Z, Sirianni L, Boutary M. Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:104–114.CrossRefPubMed
19.
Jacobson L, Chabal C, Brody MC. A dose-response study of intrathecal morphine: efficacy, duration, optimal dose and side effects. Anesth Analg. 1988;67:1082–1088.PubMed
20.
Kalso E. Effects of ITMS, injected with bupivacaine, on pain after orthopaedic surgery. Br J Anaesth. 1983;55:415–421.CrossRefPubMed
21.
Kauste A, Tuominen M, Heikkinen H, Gordon A, Kortila K. Droperidol, alizapride and metroclopramide in the prevention and treatment of postoperative emetic sequelae. Eur J Anaesthesiol. 1986;3:1–9.PubMed
22.
Maheshwari AV, Boutary M, Yun AG, Sirianni LE, Dorr LD. Multimodal analgesia without routine parenteral narcotics for total hip arthroplasty. Clin Orthop Relat Res. 2006;453:231–238.CrossRefPubMed
23.
Mallory TH, Lombardi AV, Fada RA, Dodds KL, Adams JB. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty. 2002;17(Suppl 1):129–133.CrossRefPubMed
24.
Mollmann M, Cord S, Holst D, Auf der Landwehr U. Continuous spinal anesthesia or continuous epidural anesthesia for postoperative pain control after hip replacement? Eur J Anesthesiol. 1999;16:454–461.
25.
Orkin FK. What do patients want? Preferences for immediate postoperative recovery. Anesth Analg. 1992;74:S225.
26.
Rathmell JP, Pino CA, Taylor R, Patrin T, Viani BA. Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg. 2003;97:1452–1457.CrossRefPubMed
27.
Salmon P, Hall GM, Peerbhoy D, Shenkin A, Parker C. Recovery from hip and knee arthroplasty: patients’ perspective on pain, function, quality of life, and well-being up to 6 months postoperative. Arch Phys Med Rehabil. 2001;82:360–366.CrossRefPubMed
28.
Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92.CrossRefPubMed
29.
Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50:149–151.CrossRefPubMed
30.
Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology. 1992;77:161–184.CrossRef
31.
Weingarten SR, Conner L, Riedinger M, Alter A, Brien W, Ellrodt G. Total knee replacement: a guide to reduced hospital length of stay. West J Med. 1995;163:26–30.PubMed
Metadata
Title
Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?
Authors
Timothy M. DiIorio, BS
Peter F. Sharkey, MD
Agnes M. Hewitt, MD
Javad Parvizi, MD
Publication date
01-09-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 9/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1357-x

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