[Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis].Braz J Anesthesiol. 2020 Sep - Oct; 70(5):508-519.BJ
Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists and Neurokinin-1 (NK-1) receptor antagonists, have been used to treat PONV.
To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant.
Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I-III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included.
STUDY APPRAISAL AND SYNTHESIS METHODS
All statistical assessments were conducted by a random effect approach and odds ratios and 95% Confidence Intervals were calculated.
Aprepitant 40mg and 80mg significantly reduced the incidence of vomiting 0-24hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30-0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19-0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0-24h and 0-48hours postoperatively (OR = 0.07; 95% CI 0.02-0.24; p < 0.001 and OR = 0.07; 95% CI 0.02-0.23; p < 0.001).
Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses.
SYSTEMATIC REVIEW REGISTRATION NUMBER