The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis.

Autor:	Liu Y; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Chen X; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Wang X; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Zhong H; Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., He H; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Liu Y; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Liao Y; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Pan Z; Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, China., Hu W; Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, China., Liu W; Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China., Zheng F; Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2023 Jul 21; Vol. 102 (29), pp. e34385.
DOI:	10.1097/MD.0000000000034385
Abstrakt:	Background: Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature. Methods: To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured. Results: Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: -1.09; 95% CI: -6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators. Conclusion: Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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