Aprepitant and fosaprepitant as a prophylactic antiemetic for preventing postoperative nausea and vomiting after general anaesthesia: a systematic review and meta-analysis.

BACKGROUND

Postoperative Nausea and Vomiting (PONV) is one of the patient-important outcomes, as its management reduces morbidity associated with surgery. This systematic review with meta-analysis aims to evaluate the efficacy and safety of prophylactic aprepitant and fosaprepitant within the first 24 hours after surgery in adult patients who underwent general anaesthesia. The authors The authors combined the outcomes only with identical evaluation times.

METHODS

The authors The authors searched six databases (MEDLINE, EMBASE, CENTRAL, WHO, ICTRP, SCIELO) for randomized controlled trials that compared aprepitant or fosaprepitant for PONV against control in different time assessments within the first 24 hours after surgery in adult patients who underwent general anaesthesia.

RESULTS

This systematic review includes 35 articles with 6241 participants in total. The authors The authors observed that aprepitant, from 0h to 24 h after surgery, significantly reduces the incidence of nausea (RR = 0.80, 95 % CI 0.67-0.97, I2 = 42 %, p = 0.07), vomiting (RR = 0.41, 95 % CI: 0.31-0.55, I2 = 51 %, p = 0.008), the use of rescue antiemetics (RR = 0.79, 95 % CI 0.66-0.95, I2 = 54 %, p = 0.009), and increases the complete response rate (RR = 1.19, 95 % CI 1.04-1.37, I2 = 51 %, p = 0.04). On the other hand, fosaprepitant, from 0 to 24 hours after surgery, showed a reduction only in the incidence of vomiting (RR = 0.35, 95 % CI 0.19-0.64, I2 = 33 %, p = 0.20).

CONCLUSION

Aprepitant reduces the incidence of postoperative nausea, vomiting and the use of rescue antiemetics and increases the complete response rate among adult patients from 0 to 24 hours after surgery. Fosaprepitant reduces the incidence of vomiting from 0 to 24 hours after surgery. Findings primarily reflect female patients; male applicability requires further study.

PROSPERO REGISTRY: CRD42023427076.