Comparison of aprepitant, dexamethasone, and ondansetron with dexamethasone and ondansetron for prevention of postoperative nausea and vomiting in high-risk patients undergoing laparoscopic surgeries: a randomized controlled trial in India.

Purpose: Following laparoscopic surgeries, patients often experience discomfort and dissatisfaction due to postoperative nausea and vomiting (PONV), despite using a multimodal pharmacological approach. The study compared the effects of triple drug prophylaxis with aprepitant-dexamethasone-ondansetron versus dual drug prophylaxis with dexamethasone-ondansetron in high-risk patients undergoing laparoscopic surgeries. Methods: This randomized controlled trial enrolled 201 female nonsmokers who used opioids postoperatively and underwent elective laparoscopic surgery. Patients were allocated into two groups: dual prophylactic antiemetics and placebo (control group), and triple prophylactic antiemetics with preoperative administration of aprepitant 80 mg (group A). Group A received oral aprepitant 80 mg 2 hours before the surgery, and the control group received a placebo. Patients were assessed at two time points: 2 hours after surgery, either in the postanesthesia care unit or in the ward, and 24 hours after surgery in the ward. Results: Patients in group A reported a PONV incidence of 10% as compared to 22.7% in the control group (relative risk,0.43; 95% confidence interval [CI], 0.22-0.89; adjusted p = 0.01) at 2 hours in the postoperative period. At 24 hours postoperatively, patients in group A experienced significantly lower incidence of PONV (10%) compared to the control group (29.7%; relative risk, 0.33; 95% CI, 0.17-0.64; p < 0.001). Also, the need for rescue antiemetics was reported to be lower in patients in group A. No adverse effects were reported with any of the drugs used. Conclusion: The study suggests that prophylaxis with a triple antiemetic regimen consisting of aprepitant-dexamethasone-ondansetron results in a lower incidence of PONV compared with a two-drug regimen using dexamethasone-ondansetron in high-risk patients with three or more risk factors.