Preoperative Aprepitant Decreases Postoperative Nausea After Laparoscopic Sleeve Gastrectomy

Postoperative nausea is common following bariatric surgery despite the use of enhanced recovery protocols for perioperative care.

To determine the prevalence of postoperative nausea in our sleeve gastrectomy population. To administer preoperative aprepitant and track postoperative nausea after laparoscopic sleeve gastrectomy.

Beginning in September 2022, a retrospective cohort study was conducted. We added 80 mg of oral aprepitant to a standard prophylactic antiemetic regimen, which included scopolamine, dexamethasone, and ondansetron. Utilizing an existing database at our institution, we reviewed the records of patients who underwent laparoscopic sleeve gastrectomy before and after the addition of aprepitant to the standard prophylactic antiemetic regimen. We assessed the severity and frequency of postoperative nausea and vomiting qualitatively (endorsed in postoperative-day-one house-staff note) and quantitatively (number of postoperative antiemetic doses administered beyond standard protocol).

One hundred thirty-four (134) laparoscopic sleeve gastrectomies were performed between March and November 2022. Sixty-four patients (64) received aprepitant preoperatively, while 70 did not. Groups were similar in age, BMI, and ASA class. In the aprepitant group, we noted a 41.60% reduction in nausea reported on postoperative-day-one (29.20% vs 50.00%, P=0.013) and a 30.5% reduction in absolute number of additional antiemetic doses (2.98 vs 4.29, P= 0.013). Additional antiemetics included ondansetron, metoclopramide, prochlorperazine, diphenhydramine, haloperidol, and lorazepam. Length of stay was not significantly different.

The addition of preoperative aprepitant to a multimodal protocol can reduce nausea after laparoscopic sleeve gastrectomy.