Does Preoperative Aprepitant Reduce Nausea and Emesis After Orthognathic Surgery?

Orthognathic surgery has a high rate of postoperative nausea and vomiting (PONV), which amplifies discomfort and delays recovery. Aprepitant, a neurokinin-1 receptor antagonist, has been associated with reduced PONV when used prophylactically, complementing the use of intraoperative and postoperative antiemetics. This retrospective cohort study examines the effect of a single preoperative dose of aprepitant on postorthognathic PONV. The primary predictor was aprepitant usage. The primary outcome was postoperative nausea, with emesis and rescue antiemetic use measured as secondary outcomes. Covariates included sex, age, procedure type, and procedure length. A total of 224 subjects were included with a median age of 19.9 years (IQR: 18.0, 21.8), and 54.0% (n=121) were male. Among them, 70.1% (n=157) received aprepitant preoperatively. There was no significant difference in the reported rate of nausea [43.3% (n=68) in the aprepitant group versus 35.8% (n=24) in the no aprepitant group, P=0.297], but the aprepitant group had a lower incidence of emesis [9.6% (n=15) versus 25.4% (n=17), P=0.002] and antiemetic use [55.4% (n=87) versus 73.1% (n=49), P=0.013]. After adjusting for sex, age, procedure type, and procedure length, aprepitant use was associated with a 69% reduction in emesis [OR: 0.31, 95% CI: (0.13, 0.73), P=0.008] and a 59% reduction in antiemetic use [OR: 0.41, 95% CI: (0.20, 0.83), P=0.014]. These findings support the association of prophylactic aprepitant and reduced emesis and rescue antiemetic use after orthognathic surgery.