Atsuta Jun, Inoue Satoki, Tanaka Yuu, Abe Keiko, Nakase Hiroyuki, Kawaguchi Masahiko
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8521, Japan.
Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8521, Japan.
J Anesth. 2017 Feb;31(1):82-88. doi: 10.1007/s00540-016-2267-1. Epub 2016 Oct 18.
Postoperative nausea and vomiting (PONV) is a common complication after craniotomy. Vomiting may be a potentially hazardous complication in neurosurgical patients. We compared the efficacy of fosaprepitant and droperidol for the prevention of PONV, vomiting in particular, after craniotomy.
Patients scheduled to undergo elective craniotomy were enrolled in the study and randomly divided in a double-blind manner into two groups to receive either 150 mg of fosaprepitant (group F) or 1.25 mg of droperidol (group D). Dexamethasone (9.9 mg) was given to all patients, except those with diabetes mellitus. The incidence of PONV, frequency of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery were assessed at five time intervals (0-2, 2-6, 6-24, 24-48, and 48-72 h).
Of the 200 randomized patients eligible for entry into the study, 186 were ultimately included for analysis. There were no significant differences in demographics or intraoperative variables between the two treatment groups. Over the entire 72-h post-craniotomy observation period the overall and cumulative incidence of vomiting was significantly lower in group F patients than in group D patients, while there were no between-group differences in the overall and cumulative incidence of PONV or in complete response (no PONV and no rescue antiemetic). The incidence and frequency of vomiting during each of the five observational periods were significantly lower in group F patients than group D patients, although there were no differences in the nausea score and antiemetic use between the groups.
Based on the results, fosaprepitant was more effective than droperidol in the prevention of vomiting after craniotomy over the entire 72-h study period. However, there was no difference in the incidence of nausea and antiemetic use.
术后恶心呕吐（PONV）是开颅术后常见的并发症。呕吐在神经外科患者中可能是一种潜在的危险并发症。我们比较了磷丙泊酚二钠和氟哌利多预防开颅术后PONV（尤其是呕吐）的疗效。
计划接受择期开颅手术的患者纳入本研究，并以双盲方式随机分为两组，分别接受150mg磷丙泊酚二钠（F组）或1.25mg氟哌利多（D组）。除糖尿病患者外，所有患者均给予地塞米松（9.9mg）。在术后72小时内的五个时间间隔（0 - 2、2 - 6、6 - 24、24 - 48和48 - 72小时）评估PONV的发生率、呕吐频率、恶心评分以及使用解救性止吐药的情况。
200例符合研究入组条件的随机分组患者中，最终186例纳入分析。两个治疗组在人口统计学或术中变量方面无显著差异。在开颅术后整个72小时观察期内，F组患者呕吐的总体发生率和累积发生率显著低于D组患者，而两组在PONV的总体和累积发生率或完全缓解率（无PONV且未使用解救性止吐药）方面无差异。在五个观察期的每个时间段，F组患者的呕吐发生率和频率均显著低于D组患者，尽管两组在恶心评分和止吐药使用方面无差异。
基于研究结果，在整个72小时研究期间，磷丙泊酚二钠在预防开颅术后呕吐方面比氟哌利多更有效。然而，在恶心发生率和止吐药使用方面无差异。
