Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.06.015
Brazilian Journal of Anesthesiology
Systematic Review

Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis

Antagonistas do receptor da neurocinina-1 no tratamento de náusea e vômito no pós-operatório: revisão sistemática e meta-análise

Chiaki Murakami, Nami Kakuta, Shiho Satomi, Ryuji Nakamura, Hirotsugu Miyoshi, Atsushi Morio, Noboru Saeki, Takahiro Kato, Naohiro Ohshita, Katsuya Tanaka, Yasuo M. Tsutsumi

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Abstract

Background
Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists and Neurokinin-1 (NK-1) receptor antagonists, have been used to treat PONV.

Objectives
To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant.

Data sources
Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.

Study eligibility criteria, participants, and interventions
Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included.

Study appraisal and synthesis methods
All statistical assessments were conducted by a random effect approach and odds ratios and 95% Confidence Intervals were calculated.

Results
Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 h ours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54];p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 h and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001).

Limitations
Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present.

Conclusions and implications of key findings
Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses.

Systematic review registration number
CRD42019120188.

Keywords

Postoperative nausea and vomiting;  Prophylaxis;  Treatment;  NK-1 receptor antagonists

Resumo

Histórico
Náusea e Vômito no Pós-Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5-Hidroxitriptamina3 (5-HT3) e antagonistas do receptor da Neurocinina-1 (NK-1), têm sido utilizados para tratar a NVPO.

Objetivo
Comparar o efeito antiemético dos antagonistas do receptor NK-1, incluindo o fosaprepitanto.

Fontes de dados
Foram utilizadas bases de dados on-line (PubMed, MEDLINE, Scopus, The Cochrane Library).

Critérios de elegibilidade do estudo, participantes e intervenções
Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK-1 e antagonistas do receptor 5-HT3, e que comparassem a incidência de NVPO.

Métodos de avaliação e síntese do estudo
Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%.

Resultados
As doses de 40 mg e 80 mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós-operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30‒0,54; p < 0,001 e OR = 0,32; 95% IC 0,19‒0,56; p < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0‒24 h como no período de 0‒48 horas pós-operatórias (OR = 0,07; 95% IC 0,02‒0,24; p < 0,001 e OR = 0,07; 95% IC 0,02‒0,23; p < 0,001).

Limitações
Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés.

Conclusões e implicações dos principais achados
Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós-operatório. No entanto, são necessários mais estudos para elaboração de meta-análises de melhor qualidade.

Número de registro da revisão sistemática
CRD42019120188.

Palavras-chave

Náusea e vômito no pós-operatório;  Profilaxia;  Tratamento;  Antagonistas do receptor NK-1

References

1 T.J. Gan, P. Diemunsch, A.S. Habib, et al. Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting Anesth Analg., 118 (2014), pp. 85-113

2 C.C. Apfel, E. Läärä, M. Koivuranta, et al. A Simplified risk score for predicting postoperative nausea and vomiting conclusions from cross-validations between two centers Anesthesiology., 91 (1999), pp. 693-700

3 T.J. Gan Risk Factors for postoperative nausea and vomiting Anesth Analg., 102 (2006), pp. 1884-1898

4 P. Diemunsch, T.J. Gan, B.K. Philip, et al. Aprepitant-PONV Protocol 091 International Study Group. Single-dose aprepitant vs. ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery Br J Anaesth., 99 (2007), pp. 202-211

5 T.J. Gan, C.C. Apfel, A. Kovac, et al. Aprepitant-PONV Study Group. A randomized, double-blind comparison of the NK1 antagonist, aprepitant, versus ondansetron for the prevention of postoperative nausea and vomiting Anesth Analg., 104 (2007), pp. 1082-1089

6 N. Kakuta, Y.M. Tsutsumi, Y.T. Horikawa, et al. Neurokinin-1 receptor antagonism, aprepitant, effectively diminishes post-operative nausea and vomiting while increasing analgesic tolerance in laparoscopic gynecological procedures J Med Invest., 58 (2011), pp. 246-251

7 K.C. Lasseter, J. Gambale, B. Jin, et al. Tolerability of fosaprepitant and bioequivalency to aprepitant in healthy subjects J Clin Pharmacol., 47 (2007), pp. 834-840

8 Y.M. Tsutsumi, N. Kakuta, T. Soga, et al. The effects of intravenous fosaprepitant and ondansetron for the prevention of postoperative nausea and vomiting in neurosurgery patients: a prospective, randomized, double-blinded study Biomed Res Int., 2014 (2014), Article 307025

9 T. Soga, K. Kume, N. Kakuta, et al. Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study J Anesth., 29 (2015), pp. 696-701

10 N. Kakuta, K. Kume, E. Hamaguchi, et al. The effects of intravenous fosaprepitant and ondansetron in the prevention of postoperative nausea and vomiting in patients who underwent lower limb surgery: a prospective, randomized, double-blind study J Anesth., 29 (2015), pp. 836-841

11 J. Atsuta, S. Inoue, Y. Tanaka, et al. Fosaprepitant versus droperidol for prevention of PONV in craniotomy: a randomized double-blind study J Anesth., 31 (2017), pp. 82-88

12 P.M. Singh, A. Borle, V. Rewari, et al. Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis Postgrad Med J., 92 (2016), pp. 87-98

13 V. Milnes, A. Gonzalez, V. Amos Aprepitant: a new modality for the prevention of postoperative nausea and vomiting: an evidence-based review J Perianesth Nurs., 30 (2015), pp. 406-417

14 M. Liu, H. Zhang, B.X. Du, et al. Neurokinin-1 receptor antagonists in preventing postoperative nausea and vomiting: a systematic review and meta-analysis Medicine (Baltimore)., 94 (2015), p. e762

15 D. Moher, A. Liberati, J. Tetzlaff, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement BMJ., 339 (2009), p. b2525

16 J.P. Higgins, D.G. Altman, P.C. Gøtzsche, et al. Cochrane Bias Methods Group. Cochrane Statistical Methods Group. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials BMJ, 343 (2011), p. d5928

17 G. Guyatt, A.D. Oxman, E.A. Akl, et al. GRADE guidelines:1. Introduction-GRADE evidence profiles and summary of findings tables J Clin Epidemiol., 64 (2011), pp. 383-394

18 J.H. Yoo, S.I. Kim, J.W. Chung, et al. Aprepitant in combination with palonosetron for the prevention of postoperative nausea and vomiting in female patients using intravenous patient-controlled analgesia Korean J Anesthesiol., 71 (2018), pp. 440-446

19 L.C. De Morais, A.M. Sousa, G.F. Flora, et al. Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: a double-blind, randomized trial Acta Anaesthesiol Scand., 62 (2018), pp. 483-492

20 S.Y. Ham, Y.H. Shim, E.H. Kim, et al. Aprepitant for antiemesis after laparoscopic gynaecological surgery: a randomised controlled trial Eur J Anaesthesiol., 33 (2016), pp. 90-95

21 J.B. Long, L. Galdi, J.G. Hentz, et al. Prevention of postoperative nausea and vomiting in elective hysterectomy: a prospective, randomized, placebo controlled outcomes trial of aprepitant NK-1 receptor antagonist Open J Anesthesiol., 4 (2014), pp. 301-307

22 A.C. Sinha, P.M. Singh, N.W. Williams, et al. Aprepitant’s prophylactic efficacy in decreasing postoperative nausea and vomiting in morbidly obese patients undergoing bariatric surgery Obes Surg., 24 (2014), pp. 225-231

23 H.Y. Moon, C.W. Baek, G.J. Choi, et al. Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomized trial BMC Anesthesiol., 14 (2014), p. 68

24 C.S. Lim, Y.K. Ko, Y.H. Kim, et al. Efficacy of the oral neurokinin-1 receptor antagonist aprepitant administered with ondansetron for the prevention of postoperative nausea and vomiting Korean J Anesthesiol., 64 (2013), pp. 212-217

25 M.C. Vallejo, A.L. Phelps, J.W. Ibinson, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery Plast Reconstr Surg., 129 (2012), pp. 519-526

26 A. Altorjay, T. Melson, T. Chinachoit, et al. Casopitant and ondansetron for postoperative nausea and vomiting prevention in women at high risk for emesis: a phase 3 study Arch Surg., 146 (2011), pp. 201-206

27 S.J. Lee, S.M. Lee, S.I. Kim, et al. The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone Korean J Anesthesiol., 63 (2012), pp. 221-226

28 T.J. Gan, J. Gu, N. Singla, et al. Rolapitant Investigation Group. Rolapitant for the prevention of postoperative nausea and vomiting: a prospective, double-blinded, placebo-controlled randomized trial Anesth Analg., 112 (2011), pp. 804-812

29 A.S. Habib, J.C. Keifer, C.O. Borel, et al. A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy Anesth Analg., 112 (2011), pp. 813-818

30 N.K. Singla, S.K. Singla, F. Chung, et al. Phase II study to evaluate the safety and efficacy of the oral neurokinin-1 receptor antagonist casopitant (GW679769) administered with ondansetron for the prevention of postoperative and postdischarge nausea and vomiting in high-risk patients Anesthesiology., 113 (2010), pp. 74-82

31 M. Aapro, A. Carides, B.L. Rapoport, et al. Aprepitant and fosaprepitant: a 10-year review of efficacy and safety Oncologist., 20 (2015), pp. 450-458
 

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