Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA,
Obes Surg. 2014 Feb;24(2):225-31. doi: 10.1007/s11695-013-1065-1.
Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.
After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.
Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3%) compared to group P (15%; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan-Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67%). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.
In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.
术后恶心和呕吐是患者对手术不满意的主要原因。对于减重手术，增加呕吐/干呕不利于手术吻合。本研究评估了阿瑞匹坦（神经激肽-1 抑制剂）作为腹腔镜减重手术肥胖患者预防性止吐药的疗效。
经机构审查委员会批准，125 例病态肥胖患者被纳入这项双盲安慰剂对照试验。随机分组后，患者在手术前 1 小时分别接受阿瑞匹坦（80 mg）片（A 组）或外观相似的安慰剂（P 组）。所有患者在术中均接受静脉注射昂丹司琼（4 mg）。术后由盲法评估者评估患者在 30 分钟、1 小时、2 小时、6 小时、24 小时、48 小时和 72 小时的恶心和呕吐情况。
两组患者的年龄、体重指数、手术类型和长度均均匀分布。72 小时时呕吐的累积发生率在 A 组（3%）明显低于 P 组（15%；p=0.021）。与 A 组相比，P 组呕吐的优势比为 5.47 倍。在 Kaplan-Meier 图上，A 组首次呕吐的时间也明显延迟（p=0.019）。与 P 组相比，A 组有更多的患者完全没有恶心或呕吐（42.18%比 36.67%）。另一方面，阿瑞匹坦对恶心评分没有影响，在任何测量时间点两组之间均无显著差异。
在接受腹腔镜减重手术的病态肥胖患者中，奥丹司琼联合阿瑞匹坦可显著延迟呕吐发作，同时降低术后呕吐的发生率。
