Korean J Anesthesiol.  2019 Aug;72(4):344-350. 10.4097/kja.d.18.00355.

Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens

• Holder-Murray J
• Esper SA
• Boisen ML
• Gealey J
• Meister K
• Medich DS
• Subramaniam K

• KMID: 2458319
• DOI: http://doi.org/10.4097/kja.d.18.00355

Abstract

BACKGROUND
Enhanced recovery protocols (ERP) provide optimal perioperative care for surgical patients. Postoperative nausea and vomiting (PONV) is common after colorectal surgery (CRS). We aim to compare the efficacy of aprepitant to a cost-effective alternative, perphenazine, as components of triple antiemetic prophylaxis in ERP patients.
METHODS
Patients who underwent ERP CRS at a single institution from July 2015 to July 2017 were evaluated retrospectively. Only subjects who received aprepitant (Group 1) or perphenazine (Group 2) preoperatively for PONV prophylaxis were included. Patient characteristics, simplified Apfel PONV scores, perioperative medications, and PONV incidence were compared between the groups. PONV was defined as the need for rescue antiemetics on postoperative days (POD) 0-5.
RESULTS
Five hundred ninety-seven patients underwent CRS of which 498 met the inclusion criteria. Two hundred thirty-one (46.4%) received aprepitant and 267 (53.6%) received perphenazine. The incidence of early PONV (POD 0-1) was comparable between the two groups: 44.2% in Group 1 and 44.6% in Group 2 (P = 0.926). Late PONV (POD 2-5) occurred less often in Group 1 than Group 2, respectively (35.9% vs. 45.7%, P = 0.027). After matching the groups for preoperative, procedural, and anesthesia characteristics (164 pairs), no difference in early or late PONV could be demonstrated between the groups.
CONCLUSIONS
The incidence of PONV remains high despite most patients receiving three prophylactic antiemetic medications. Perphenazine can be considered a cost-effective alternative to oral aprepitant for prophylaxis of PONV in patients undergoing CRS within an ERP.

Keyword

Aprepitant; Colectomy; Colorectal surgery; Enhanced recovery; Perphenazine; Postoperative nausea and vomiting

MeSH Terms

Anesthesia
Antiemetics
Colectomy
Colorectal Surgery*
Humans
Incidence
Perioperative Care
Perphenazine
Postoperative Nausea and Vomiting*
Retrospective Studies
Antiemetics
Perphenazine