Fosaprepitant versus Ondansetron for Preventing Postoperative Nausea and Vomiting After Video-Assisted Thoracoscopic...

Postoperative nausea and vomiting (PONV) is a frequent complication after video-assisted thoracoscopic lung resection, particularly in patients at moderate to high risk, and substantially hinders recovery. Fosaprepitant, a neurokinin-1 (NK-1) receptor antagonist, is approved for PONV prevention; however, its efficacy in video-assisted thoracoscopic lung resection remains uncertain. This randomized trial evaluated the efficacy of fosaprepitant versus ondansetron in preventing PONV in high-risk patients undergoing video-assisted thoracoscopic lung resection.

In this prospective, double-blind, randomized controlled clinical trial, 233 adults aged 18-70 years undergoing elective video-assisted thoracoscopic lung resection with an Apfel score ≥ 2 were randomized 1:1 to receive intravenous fosaprepitant 150 mg or ondansetron 8 mg, each combined with dexamethasone 5 mg. The primary outcome was the incidence of PONV at 24 hours postoperatively. Secondary outcomes included the incidence and severity of PONV at 6, 12, and 48 hours postoperatively, the use of rescue antiemetics, adverse events, and recovery outcomes.

The 24-hour incidence of PONV was 31.0% [36] in the fosaprepitant group and 41.0% [48] in the ondansetron group (OR, 0.76; 95% CI, 0.53 to 1.07; P=0.112). Fosaprepitant significantly reduced PONV at 48 hours (10.3% [12] vs 20.5% [24]; OR, 0.51; 95% CI, 0.27 to 0.96; P=0.032), as well as vomiting at 24 hours (8.6% [10] vs 21.4% [25]; OR, 0.40; 95% CI, 0.20 to 0.80; P=0.006) and 48 hours (0% [0] vs 5.1% [6]; OR, 0.07; 95% CI, 0.00 to 1.32; P=0.040).

Fosaprepitant was superior to ondansetron in preventing early postoperative vomiting and delayed-phase PONV, and it represents an effective antiemetic strategy for high-risk thoracic surgical patients.

Registration number, NCT05881486; https://clinicaltrials.gov.