Aprepitant plus ondansetron compared with ondansetron alone in reducing
postoperative nausea and vomiting in ambulatory patients undergoing plastic
Author(s): Vallejo MC, Phelps AL, Ibinson JW, Barnes LR, Milord PJ, Romeo RC, Williams BA,
Affiliation(s): Department of Anesthesiology, Magee-Womens Hospital of the University of
Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213, USA.
Publication date & source: 2012, Plast Reconstr Surg. , 129(2):519-26
BACKGROUND: Postoperative nausea and vomiting is a major challenge in the
perioperative setting. The incidence can be as high as 80 percent, and the
majority of the symptoms among outpatients occur after discharge. This study
evaluated the efficacy of a neurokinin-1 receptor antagonist (aprepitant) in
reducing postoperative symptoms for up to 48 hours in patients undergoing
outpatient plastic surgery.
METHODS: A prospective, double-blinded, randomized, two-arm evaluation of 150
ambulatory plastic surgery patients receiving a standardized general anesthetic,
including postoperative nausea and vomiting prophylaxis with ondansetron and
either aprepitant or placebo, was performed. The main outcome measures were the
occurrence of vomiting and the severity of nausea for up to 48 hours
RESULTS: Overall, 9.3 percent of patients who received aprepitant versus 29.7
percent in group B had vomiting, with the majority of vomiting episodes occurring
after hospital discharge. The Kaplan-Meier plot of the hazards of vomiting
revealed an increased incidence of emesis in patients receiving ondansetron alone
compared with the combination of ondansetron and aprepitant (p = 0.006). The
incidence of nausea was not significantly different in the two groups. Severity
of nausea, however, was significantly higher in those receiving ondansetron alone
compared with those receiving ondansetron and aprepitant, as measured by a peak
nausea score (p = 0.014) and by multivariate analysis of variance results
comparing repeated verbal rating scale scores over 48 hours after surgery (p =
CONCLUSION: In patients undergoing plastic surgery, the addition of aprepitant to
ondansetron significantly decreases postoperative vomiting rates and nausea
severity for up to 48 hours postoperatively.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.