Does Preoperative Aprepitant Reduce Nausea and Emesis After Orthognathic Surgery?

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Pharmacology

Background:

• Postoperative nausea and vomiting (PONV) is a common complication following orthognathic surgery, leading to increased patient discomfort and delayed recovery.
• Aprepitant, a neurokinin-1 receptor antagonist, is recognized for its efficacy in preventing PONV when administered prophylactically.
• This study investigates the specific impact of preoperative aprepitant on PONV outcomes in orthognathic surgery patients.

Purpose of the Study:

• To evaluate the effectiveness of a single preoperative dose of aprepitant in reducing postoperative nausea, emesis, and the need for rescue antiemetics after orthognathic surgery.
• To analyze the association between aprepitant administration and key PONV indicators in this patient population.

Main Methods:

• A retrospective cohort study design was employed, analyzing data from 224 orthognathic surgery patients.
• The primary predictor variable was the administration of a single preoperative dose of aprepitant.
• Outcomes measured included postoperative nausea, emesis, and rescue antiemetic use, with adjustments for covariates such as sex, age, procedure type, and duration.

Main Results:

• While no significant difference was observed in the rate of postoperative nausea between groups, aprepitant administration was linked to a significantly lower incidence of emesis (9.6% vs. 25.4%, P=0.002).
• Patients receiving preoperative aprepitant also showed a reduced need for rescue antiemetics (55.4% vs. 73.1%, P=0.013).
• Multivariate analysis confirmed that aprepitant use was associated with a 69% reduction in emesis and a 59% reduction in antiemetic use.

Conclusions:

• Prophylactic preoperative aprepitant is associated with a significant reduction in emesis and the requirement for rescue antiemetics following orthognathic surgery.
• These findings support the integration of aprepitant into perioperative antiemetic regimens to improve patient outcomes and recovery after orthognathic procedures.