Is Aprepitant Effective in Preventing Postoperative Nausea and Vomiting?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not aprepitant is effective in preventing postoperative nausea and vomiting. STUDY DESIGN: Review of three English language primary randomized controlled trials from 2012-2014. DATA SOURCES: Three double-blind, randomized controlled trials comparing oral aprepitant with placebo. All articles were found using PubMed. OUTCOMES MEASURED: The three studies measured nausea severity using a verbal rating system and number of episodes of nausea and vomiting recorded by a blinded study investigator. RESULTS: Vallejo et al found that 29.7% of the patients in the placebo group vomited compared to 9.3% of the patients who received aprepitant (p = 0.003). They also found that the worst VRS nausea score was a 5 out of 10 in the group of patients who received aprepitant versus 8 out of 10 for the placebo group (p = 0.014). Jung et al found that the groups that received aprepitant had a 35% incidence of nausea compared to 63% in the placebo group (p = 0.0025). In addition, the aprepitant groups both had 0% incidence of vomiting compared to the placebo group, which had a 20% incidence (p = 0.005). Sinha et al found that incidence of vomiting at 72 hours was 3.1% in the experimental group and 15.0% in the placebo group (p = 0.021). In all of the studies, mean VRS nausea scores were lower but were not found to be statistically significant. CONCLUSIONS: Aprepitant is effective in preventing incidence of nausea and vomiting, but is not found to significantly decrease average nausea rating scores