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Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens / 대한마취과학회지
Korean Journal of Anesthesiology ; : 344-350, 2019.
Article in English | WPRIM | ID: wpr-759550
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.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Perphenazine / Incidence / Retrospective Studies / Colectomy / Colorectal Surgery / Perioperative Care / Postoperative Nausea and Vomiting / Anesthesia / Antiemetics Type of study: Incidence study / Observational study / Prognostic study Limits: Humans Language: English Journal: Korean Journal of Anesthesiology Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Perphenazine / Incidence / Retrospective Studies / Colectomy / Colorectal Surgery / Perioperative Care / Postoperative Nausea and Vomiting / Anesthesia / Antiemetics Type of study: Incidence study / Observational study / Prognostic study Limits: Humans Language: English Journal: Korean Journal of Anesthesiology Year: 2019 Type: Article