Fosaprepitant for postoperative nausea and vomiting in patients undergoing laparoscopic gastrointestinal surgery: a randomised trial

作者：Qingshan Huang, Fan Wang, Chujun Liang, Yabin Huang, Yingyin Zhao, Yingyin Zhao, Chuling Liu, Chunmeng Lin, Lizhen Zhang, Shaoli Zhou, Qiuling Wang, Shan Li, Rongyue Gong, Qian Wu, Yuting Gu, Jinxin Zhang, Tongfeng Luo, Wei Wang, Song Zhang, Nassirou Bizo Mailoga, Kai Wang, Sanqing Jin, Yang Zhao, Yang Zhao · 发表于：British Journal of Anaesthesia · 年份：2023 · DOI：10.1016/j.bja.2023.06.029 · 被引用次数：45 · 研究领域：Nausea and vomiting management、Enhanced Recovery After Surgery、Anesthesia and Pain Management

BACKGROUND: Postoperative nausea and vomiting (PONV) is a major problem after surgery. Even with double prophylactic therapy including dexamethasone and a 5-hydroxytryptamine-3 receptor antagonist, the incidence is still high in many at-risk patients. Fosaprepitant, a neurokinin-1 receptor antagonist, is an effective antiemetic, but its efficacy and safety in combination antiemetic therapy for preventing PONV remain unclear. METHODS: In this randomised, controlled, double-blind trial, 1154 participants at high risk of PONV and undergoing laparoscopic gastrointestinal surgery were randomly assigned to either a fosaprepitant group (n=577) receiving fosaprepitant 150 mg i.v. dissolved in 0.9% saline 150 ml, or a placebo group (n=577) receiving 0.9% saline 150 ml before anaesthesia induction. Dexamethasone 5 mg i.v. and palonosetron 0.075 i.v. mg were each administered in both groups. The primary outcome was the incidence of PONV (defined as nausea, retching, or vomiting) during the first 24 postoperative hours. RESULTS: The incidence of PONV during the first 24 postoperative hours was lower in the fosaprepitant group (32.4% vs 48.7%; adjusted risk difference -16.9% [95% confidence interval: -22.4 to -11.4%]; adjusted risk ratio 0.65 [95% CI: 0.57 to 0.76]; P<0.001). There were no differences in severe adverse events between groups, but the incidence of intraoperative hypotension was higher (38.0% vs 31.7%, P=0.026) and intraoperative hypertension (40.6% vs 49.2%, P=0.003) was lo...