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Randomized, double-blind comparison of oral aprepitant alone compared with aprepitant and transdermal scopolamine for prevention of postoperative nausea and vomiting
Journal article   Open access   Peer reviewed

Randomized, double-blind comparison of oral aprepitant alone compared with aprepitant and transdermal scopolamine for prevention of postoperative nausea and vomiting

M. S Green, P Green, S. N Malayaman, M Hepler, L. J Neubert and J. C Horrow
British journal of anaesthesia : BJA, v 109(5), pp 716-722
Nov 2012
DOI: https://doi.org/10.1093/bja/aes233
PMID: 22831888
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1093/bja/aes233View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Open

Abstract

autonomic agents, antiemetics central nervous system agents, adjuvants anaesthesia tropanes, scopolamine receptors, neurokinin-1 postoperative nausea and vomiting
Background Aprepitant blocks the emetic effects of substance P. Scopolamine antagonizes muscarinic type 1 and histamine type 1 receptors. This study compares monotherapy and multimodal therapy by looking at complete response, nausea, vomiting, and rescue medication in patients at high risk for postoperative nausea and vomiting (PONV) treated with oral aprepitant with or without scopolamine. Methods We enrolled 120 patients in this randomized, double-blind trial. Inclusion criteria were: >18 yr old, ASA I–III, two or more Apfel four-point risk factors, undergoing an elective surgical procedure with a high risk of PONV expected to last at least 60 min. The primary outcome variable was complete response, that is, no emesis and no rescue therapy from 0 to 24 h. The outcomes measured included the incidences of nausea, vomiting, their composite, and the need for rescue medication. Results The aprepitant alone and aprepitant with scopolamine did not differ in complete responses (63% vs 57%, P=0.57) or net clinical benefit (26% vs 19%, P=0.38). The number who did not experience PONV and who used rescue medication did not differ. The incidence of PONV in the post-anaesthesia care unit did not differ nor did the use of rescue medications. Conclusions This trial evaluating the effectiveness of aprepitant alone and in combination with scopolamine showed no difference between treatment groups. The primary objective, complete response, and secondary objectives, incidences of nausea, vomiting, their composite, and the need for rescue medication, all showed no statistical difference.

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20 citations in Web of Science
25 citations in Scopus

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Web of Science research areas
Anesthesiology
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