Ashoor Tarek M, Kassim Dina Y, Esmat Ibrahim M
Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Department of Anesthesia and Intensive Care, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
Anesthesiol Res Pract. 2022 Apr 30;2022:3541073. doi: 10.1155/2022/3541073. eCollection 2022.
Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone () alone for prevention of PONV in morbidly obese patients undergoing LSG.
Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.
The A/D and M/D groups were superior to the group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the group). The group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery ( < 0.001, < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the group (=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements ( < 0.001, < 0.001, < 0.001, respectively). The A/D and M/D groups were superior to the group with regard to the patient satisfaction score ( < 0.001).
Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.
不同止吐药联合使用已被证明可降低腹腔镜袖状胃切除术（LSG）后的术后恶心和呕吐（PONV）。本试验比较了阿瑞匹坦/地塞米松（A/D）联合用药、米氮平/地塞米松（M/D）联合用药与单独使用地塞米松（）预防接受LSG的病态肥胖患者发生PONV的效果。
90例计划接受LSG的患者被随机分配，组仅接受8mg地塞米松静脉输注（IVI），A/D组在接受8mg地塞米松IVI的基础上还服用80mg阿瑞匹坦胶囊，M/D组在接受8mg地塞米松IVI的基础上还服用30mg米氮平片。在0-2小时（早期）和2-24小时（晚期）对PONV进行评估。主要结局是术后0-24小时的完全缓解情况。总体PONV、术后疼痛、副作用和患者满意度评分被视为次要结局。
A/D组和M/D组在术后0-24小时内的完全缓解情况优于组（A/D组为79.3%，M/D组为78.6%，组为20.7%）。在术后0-24小时的总体PONV和使用补救性止吐药方面，组不如A/D组和M/D组（分别为P<0.001，P<0.001）。与组相比，M/D组的恶心峰值评分（2-24小时）显著降低（P=0.005）。M/D组患者的镇静评分较高，而A/D组患者的疼痛评分较低（2-24小时）且镇痛需求较少（分别为P<0.001，P<0.001，P<0.001）。在患者满意度评分方面，A/D组和M/D组优于组（P<0.001）。
在减轻计划接受腹腔镜袖状胃切除术的病态肥胖患者的术后恶心和呕吐方面，阿瑞匹坦/地塞米松联合用药和米氮平/地塞米松联合用药优于单独使用地塞米松。试验注册号：ClinicalTrials.gov标识符：NCT04013386。
