Combining aprepitant with dexamethasone for the prevention of postoperative nausea and vomiting
Man Ling Lai1, Yee Kwon Tang2, Benny Cheng3, Patricia Kan1, Zoe Fu1, Doris Ng4, PM Yuen4,5, Tony Gin1, Matthew Chan1
Departments of Anaesthesia and Intensive Care:
1The Chinese University of Hong Kong
2Pamela Youde Nethersole Eastern Hospital
3Tuen Mun Hospital
Department of Obstetrics and Gynaecology:
4The Chinese University of Hong Kong
5The Hong Kong Sanatorium
When given alone, aprepitant (a neurokinin1 antagonist) or dexamethasone have limited efficacy for the prevention of postoperative nausea and vomiting (PONV). We compared the efficacy of aprepitant plus dexamethasone with each agent alone for preventing PONV in patients undergoing open abdominal hysterectomy.
Methods: This was a double-blinded, randomized study. A total of 240 patients undergoing abdominal hysterectomy were randomized to 3 treatment groups: aprepitant 80 mg, dexamethasone 4 mg and aprepitant 80 mg plus dexamethasone 4 mg, taken 1 hour prior to surgery. The incidence of PONV, side effects and analgesic requirement were recorded for 48 hours after surgery.
Results: Patient characteristics, operative details, postoperative pain score and morphine consumption were similar between groups. When dexamethasone was combined with aprepitant, there was significant increase in treatment response (92%, P<0.01).
Table 1. Incidence of postoperative nausea and vomiting
| Time | Aprepitant 80 mg | Dexamethasone 4 mg | Aprepitant 80 mg + Dexamethasone 4 mg |
| No. of patients | 80 | 80 | 80 |
| 0-6 h | 27% | 21% | 6% |
| 6-48 h | 5% | 7% | 2% |
| 0-48 h | 31% | 28% | 8% |
Conclusions: The antiemetic efficacy of aprepitant was similar to dexamethasone. The combination of aprepitant with dexamethasone was significantly more effective than either agent alone. for prevention of PONV.
