Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor.
Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, 1414 Kuhl Ave., Orlando, FL.
Surg Laparosc Endosc Percutan Tech. 2023 Jun 1;33(3):265-269. doi: 10.1097/SLE.0000000000001101.
Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen.
This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction.
Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47±20.54 United States Dollars in the no-Fosaprepitant group to 25.69±14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37±0.745 versus 7.61±5.202 for ondansetron ( P =0.001), 92±1.279 versus 2.21±2.399 for promethazine ( P =0.001), 0.25±0.685 versus 1.41±0.577 for scopolamine patch ( P =0.001), and 0.05±0.218 versus 1.14±0.398 for dexamethasone ( P =0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group.
Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.
术后恶心和呕吐（PONV）是麻醉和手术最常见的不良反应之一，导致患者不适和不满意。最新研究表明，NK-1 受体拮抗剂在 PONV 管理中的疗效及其在化疗性恶心预防中的应用。本文作者希望提供使用福沙匹坦（fosaprepitant）作为单一疗法在术后护理中的证据，以替代多药物标准护理方案。
这是一项对 400 名接受标准止吐治疗方案或接受福沙匹坦（福沙匹坦组和非福沙匹坦组）治疗的患者进行回顾性图表分析。本研究的主要结局是评估福沙匹坦（静脉内给药）对围手术期止吐药物使用、治疗成本和患者满意度的影响。
福沙匹坦替代标准护理方案后，PONV 药物总费用降低，非福沙匹坦组为 46.47±20.54 美元，福沙匹坦组为 25.69±14.84 美元。两组之间止吐药物剂量显著减少：昂丹司琼从 0.37±0.745 降至 7.61±5.202（P=0.001），异丙嗪从 92±1.279 降至 2.21±2.399（P=0.001），东莨菪碱贴片从 0.25±0.685 降至 1.41±0.577（P=0.001），地塞米松从 0.05±0.218 降至 1.14±0.398（P=0.001）。通过问卷调查衡量的患者满意度在福沙匹坦组中提高了 11.6%。
福沙匹坦是预防和治疗肥胖/代谢手术患者 PONV 的一种相关替代方案。
