Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy
Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy
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DOI：
10.1007/s00540-012-1529-9
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发表时间：
2013-06-01
影响因子：
2.8
通讯作者：
Yang, Hong Seuk
中科院分区：
文献类型：
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作者：
Jung, Wol Seon;Kim, Yong Beom;Yang, Hong Seuk
术后使用阿片类药物与术后恶心和呕吐（PONV）的发生率较高相关。我们进行了一项前瞻性、随机、双盲、安慰剂对照研究，以研究口服阿瑞匹坦（一种神经激肽-1受体拮抗剂）对减少芬太尼类药物患者PONV的影响，妇科腹腔镜术后静脉自控镇痛（PCA），120例女性患者（年龄21-60岁）接受腹腔镜子宫切除术的患者被随机分配接受80 mg A80组（n = 40）、A125组（n = 40）或对照组（n = 40）在麻醉诱导前2 h口服阿瑞匹坦125 mg。麻醉维持异氟烷和瑞芬太尼，并使用芬太尼和酮咯酸PCA IV术后48小时。术后2、24和48小时记录恶心、呕吐/干呕的发生率以及补救止吐药的使用情况。完全缓解定义为无PONV且不需要补救治疗。在前48小时内，A80和A125组的完全缓解发生率显著低于对照组，分别为56%和63% vs. 28%，P = 0.007和P = 0.003，分别为65%和65% vs. 38%，P = 0.025。A80组与A125组的完全缓解率和PONV发生率差异无统计学意义，口服阿瑞匹坦80 mg可有效降低妇科腹腔镜术后芬太尼PCA患者麻醉后48 h内的PONV发生率。
The use of opioids following surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). We conducted a prospective, randomized, double-blind, placebo-controlled study to investigate the effect of orally administered aprepitant, a neurokinin-1 receptor antagonist, for reducing PONV in patients with fentanyl-based, patient-controlled analgesia (PCA) given intravenously after gynecological laparoscopy.One hundred and twenty female patients (ages 21-60) undergoing laparoscopic hysterectomy were randomly allocated to receive 80 mg (A80 group, n = 40) or 125 mg aprepitant (A125 group, n = 40) or placebo (control group, n = 40) orally 2 h before anesthesia induction. Anesthesia was maintained with isoflurane and remifentanil, and PCA IV using fentanyl and ketorolac were provided for 48 h after surgery. Incidences of nausea, vomiting/retching, and use of rescue antiemetics were recorded at 2, 24, and 48 h after surgery. Complete response was defined as no PONV and no need for rescue treatment.The incidence of complete response was significantly lower in the A80 and A125 groups than in controls, 56 % and 63 %, vs. 28 %, respectively, P = 0.007 and P = 0.003, respectively, during the first 48 h, and 65 % and 65 % vs. 38 %, respectively, both P = 0.025, during the first 2 h. However, there were no statistically significant differences between A80 and A125 groups in the incidences of complete response and PONV during the study period.Aprepitant 80 mg orally was effective in lowering the incidence of PONV in the first 48 h after anesthesia in patients receiving fentanyl-based PCA after gynecological laparoscopy.