Antiemetic activity of Fosaprepitant as a rescue agent in patients with
postoperative nausea and vomiting after orthopedic surgery
Abstract
Backgroud: Postoperative nausea and vomiting (PONV) is a common
postoperative complication in the surgical setting. Many agents exist
for PONV prophylaxis but rescue options remains a big challenge.
Fosaprepitant has been studied in PONV prophylaxis but the data is
limited when utilized for rescue. Methods: In this single center
retrospecitve chart review, the antiemetic activity of fosaprepitant
(selective NK1 receptor antagonist) was investigated as a rescue agent
for PONV in patients undergoing orthopedic surgery. Based on the
institutional protocol, fosaprepitant was only utilized in patients with
an existing history of PONV or when 2 antiemtic agents were exhausted
with no success in the postoperative period. The groups evaluated are
inferred to be patients with and without emesis relief. Chart reviews,
progress notes and clinical interventions were utilized to assess emesis
relief. Results: 383 total patients (over a 12 month period) fell into
the hospital protocol and approved to receive fosaprepitant as a rescue
agent. Out of the 383 patients, 286 had relief with fosaprepitant, and
196 patients did not require further antiemetic therapy. Patient
demographs, anesthesia type, additional medications and surgical types
were all assessed thoroughly. Three surgical types showed the most
prominent significance for fosaprepirtant PONV relief: Sports management
and shoulder 76% (p = 0.0012). Adult Reconstruction and Joint
Replacement 74% (<0.0001), Spine 61% (p = 0.015),
Conclusion: The data shows their may be potential for utilizing
fosaprepitant as a rescue agent for PONV in the orthopedic setting. A
bigger study with a larger sample size is warranted.