Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Postoperative Nausea and Vomiting | Research

Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial

Authors: Mostafa Alam, Alireza Shakeri, Ardeshir Khorsand, Karim Nasseri, Sadaf Nasseri

Published in: BMC Anesthesiology | Issue 1/2023

Login to get access

Abstract

Background

Postoperative nausea and vomiting (PONV) is a common side effect associated with general anesthesia. Both ondansetron and aprepitant been effectively used to prevent PONV. However, there is a disagreement of opinions regarding the superiority of these two drugs. This study aims to compare the efficacy of aprepitant with ondansetron in preventing PONV following orthognathic surgeries.

Methods

In this double-blinded clinical trial, 80 patients scheduled for orthognathic surgery at Imam Hossein Hospital, Tehran, Iran, were randomly assigned to two groups. A standardized anesthesia protocol was used for all patients. The first group received a placebo capsule administered one hour before the surgical procedure along with 4 mg (2 ml) of ondansetron intravenously after anesthesia induction. The second group was given 80 mg aprepitant capsules one hour before the surgery, followed by an injection of 2 ml intravenous distilled water after anesthesia induction.
The occurrence and severity of PONV, the amount of rescue medication required, and the complete response of patients assessed within 24 h after the surgery.

Results

There were no significant differences in demographic data between the two groups. Patients in the aprepitant group had a significantly lower incidence and severity of nausea (2.5% versus 27.5%), vomiting (5% versus 25%), and required fewer rescue medications (7.5% versus 62.5%) compared to the ondansetron group. Additionally, the aprepitant group showed a higher complete response rate (90% versus 67.5%) in the 0-2 and 12-24 postoperative hours.

Conclusion

According to the findings of this study, aprepitant has demonstrated a greater efficacy in preventing PONV following orthognathic surgery, when compared to ondansetron.

Trial registration

Iranian Registry of Clinical Trials (IRCT code: IRCT20211205053279N3), date of registration: 16/12/2022.
Literature
1.
Stoicea N, Gan TJ, Joseph N, Uribe A, Pandya J, Dalal R, et al. Alternative therapies for the prevention of postoperative nausea and vomiting. Front Med (Lausanne). 2015;16(2):87.
2.
Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742–53.CrossRefPubMed
3.
Silva AC, O’Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review. J Oral Maxillofac Surg. 2006;64(9):1385–97.CrossRefPubMed
4.
Phillips C, Brookes CD, Rich J, Arbon J, Turvey TA. Postoperative nausea and vomiting following orthognathic surgery. Int J Oral Maxillofac Surg. 2015;44(6):745–51.CrossRefPubMedPubMedCentral
5.
Rajeeva V, Bhardwaj N, Batra YK, Dhaliwal LK. Comparison of ondansetron with ondansetron and dexamethasone in prevention of PONV in diagnostic laparoscopy. Can J Anaesth. 1999;46(1):40–4.CrossRefPubMed
6.
Gan TJ, Apfel CC, Kovac A, Philip BK, Singla N, Minkowitz H, et al. A randomized, double-blind comparison of the NK1 antagonist, aprepitant, versus ondansetron for the prevention of postoperative nausea and vomiting. Anesth Analg. 2007;104(5):1082–9. tables of contents.CrossRefPubMed
7.
Ashoor TM, Kassim DY, Esmat IM. A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs Mirtazapine/Dexamethasone. Anesthesiol Res Pract. 2022;2022:3541073.PubMedPubMedCentral
8.
Singh PM, Borle A, Rewari V, Makkar JK, Trikha A, Sinha AC, et al. Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis. Postgrad Med J. 2016;92(1084):87–98.CrossRefPubMed
9.
Diemunsch P, Gan TJ, Philip BK, Girao MJ, Eberhart L, Irwin MG, Aprepitant-PONV Protocol 091 International Study Group, et al. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery. Br J Anaesth. 2007;99(2):202–11.CrossRefPubMed
10.
Barzanji A, Nasseri K, Sadeghi S, Ardalan M, Nouri B, Daseh K. Comparing the effect of ondansetron-dexamethasone and metoclopramide-dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized double-blind clinical trial. Adv Biomed Res. 2022;30(11):44.
11.
Grigio TR, Sousa AM, Magalhães GGN, Ashmawi HA, Vieira JE. Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial. Clinics (Sao Paulo). 2020;75:e1688.CrossRefPubMed
12.
Apipan B, Rummasak D, Wongsirichat N. Postoperative nausea and vomiting after general anesthesia for oral and maxillofacial surgery. J Dent Anesth Pain Med. 2016;16(4):273–81.CrossRefPubMedPubMedCentral
13.
Jeyabalan S, Thampi SM, Karuppusami R, Samuel K. Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries. Indian J Anaesth. 2019;63(4):289–94.CrossRefPubMedPubMedCentral
14.
Bergese SD, Puente EG, Antor MA, Viloria AL, Yildiz V, Kumar NA, et al. 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. Front Med (Lausanne). 2016;5(3):29.
15.
Hassan AME, Abdelzaam E-S. A comparative study between aprepitant only versus combined ondansetron and aprepitant as antiemetic therapy, regarding efficacy and duration, in patients undergoing laparoscopic bariatric surgery double-blinded, randomized control clinical trial. J Anesth Clin Res. 2019;10(5).
16.
Safarnejad F, Nasseri K, Karami R. Comparison of the effects of aprepitant and ondansetron individually and combining on postoperative nausea and vomiting after laparoscopic cholecystectomy. World J Lap Surg. 2021;14(1):39–42.
17.
Liu M, Zhang H, Du BX, Xu FY, Zou Z, Sui B, et al. Neurokinin-1 receptor antagonists in preventing postoperative nausea and vomiting: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(19):e762.CrossRefPubMed
18.
Kakuta N, Tsutsumi YM, Horikawa YT, Kawano H, Kinoshita M, Tanaka K, et al. Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures. J Med Invest. 2011;58(3–4):246–51.CrossRefPubMed
19.
Chizh BA, Gohring M, Troster A, Quartey GK, Schmelz M. Koppert W : Effects of oral pregabalin and aprepitant on pain and central sensitization in the electrical hyperalgesia model in human volunteers. Br J Anaesth. 2007;98:246–54.CrossRefPubMed
20.
Curran MP, Robinson DM. Aprepitant: a review of its use in the prevention of nausea and vomiting. Drugs. 2009;69(13):1853–78.CrossRefPubMed
Metadata
Title
Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial
Authors
Mostafa Alam
Alireza Shakeri
Ardeshir Khorsand
Karim Nasseri
Sadaf Nasseri
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02371-y

Other articles of this Issue 1/2023

BMC Anesthesiology 1/2023 Go to the issue

Correction

Correction: Comparison of the effectiveness of ultrasound-guided versus fluoroscopyguided medial lumbar bundle branch block on pain related to lumbar facet joints: a multicenter randomized controlled noninferiority study

Research

Effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery: a double-blind, randomized trial

Research

Comparative retrospective review of perioperative analgesia using ultrasound-guided programmed intermittent erector spinae plane block for video-assisted thoracoscopic lobectomy

Research

The effect of body mass index on thoracic paravertebral block analgesia after video-assisted thoracoscopic surgery; a prospective interventional study

Correction

Correction: Rate of residual neuromuscular block using single‑dose rocuronium in general anesthesia for ENT Surgery: a retrospective cohort study

Research

Pressure-controlled ventilation-volume guaranteed mode improves bronchial mucus transport velocity in patients during laparoscopic surgery for gynecological oncology: a randomized controlled study