Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures
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Purpose : Post-operative nausea and vomiting (PONV) remains the most frequentlyreported patient complaint after anesthesia. Aprepitant is the first neurokinin-1(NK1) receptor antagonism available for use as an antiemetic. We investigated whetheraprepitant can effectively decrease PONV in patients undergoing laparoscopic gynecologicalsurgery. Methods : Sixty four patients receiving general anesthesia for laparoscopicgynecological surgery were randomly assigned to either receive a preoperative dose of 80mg aprepitant or no drug. Efficacy was assessed in 2 and 24 hours after surgery. Primaryand secondary endpoints were analyzed for the time intervals 0-2 hours (acute phase)and 2-24 hours (delayed phase). Vomiting, nausea, use of rescue anti-emetic, and visualanalog scale (VAS) were assessed. Nausea was assessed on a 4-point scale, from 0 to 3.Results : Sixty patients participated in the study. At acute phase, PONV was present inboth control and NK1 group and were 63% and 43% respectively. The severity of nauseawas much less in the NK1 group. PONV prevalence at delayed phase was present in controlbut absent in NK1 group 27% vs. 0%, respectively. The amount of pain medication usedby patients in the NK1 group was significantly less for diclofenac and pentazocine suggestingincrease pain tolerance. Conclusions : Neurokinin-1 receptor antagonism effectivelylowered PONV increased pain tolerance, and expedited recovery in patients undergoinglaparoscopic gynecological surgery.
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