Background: Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications.\nPalonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared\npalonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for\nlaparoscopic gynaecologic surgery.\nMethods: Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general\nanaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral\naprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual\nanalogue scale [VAS] nausea score <4 and no use of rescue therapy) 0ââ?¬â??48 h after surgery. Nausea severity (0ââ?¬â??10)\nand use of rescue therapy were monitored for 0ââ?¬â??48 h. The secondary efficacy end points were the effect of\naprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and\nuse of rescue analgesics.\nResults: Aprepitant was non-inferior to palonosetron in terms of complete response 0ââ?¬â??48 hours after surgery (74%\nvs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than\nthat with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg\naprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were\nrequired in the aprepitant group.\nConclusions: Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for\nlaparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they\nbind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management\nin humans.
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