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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00355    [Epub ahead of print]
Published online May 17, 2019.
Postoperative nausea and vomiting (PONV) in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery (ERAS) protocol: comparison of two prophylactic antiemetic regimens
Jennifer Holder-Murray1, Stephen A Esper2, Michael L Boisen2, Julie Gealey2, Katie Meister2, David Medich1, Kathirvel Subramaniam2
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
2Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA
Corresponding author:  Kathirvel Subramaniam, Tel: 4126475635, Fax: 4126476290, 
Email: subramaniamk@upmc.edu
Received: 16 December 2018   • Revised: 25 April 2019   • Accepted: 7 May 2019
Abstract
BACKGROUND
Enhanced recovery protocols (ERP) provide optimal perioperative care for surgical patients. Postoperative nausea and vomiting (PONV) remains high in colorectal surgery (CRS). We aim to compare efficacy of aprepitant to a more cost-effective alternative, perphenazine, as components of triple antiemetic prophylaxis in ERP patients.
METHODS
Patients who underwent ERP CRS at a single institution from July 2015-July 2017 were evaluated retrospectively. Only subjects who received either aprepitant alone (Group 1) or perphenazine alone (Group 2) preoperatively for PONV prophylaxis were included. Analysis of patient characteristics, simplified Apfel PONV scores, perioperative medications, and PONV incidence were compared between groups. PONV was defined as the need for rescue antiemetics on postoperative days (POD) 0-5.
RESULTS
597 patients underwent CRS of which 498 met inclusion criteria. 231 (46.4%) received aprepitant and 267 (53.6%) received perphenazine. The incidence of early PONV (POD 0-1) was comparable between the two groups: 44.2% in Group 1 and 44.6% in Group 2 (P = 0.926). Late PONV (POD 2-5) occurred less often in Group 1 than Group 2, respectively (35.9% versus 45.7%, P = 0.027). After matching the groups for preoperative, procedural, and anesthesia characteristics (164 pairs), no difference in early or late antiemetic efficacy could be demonstrated between the groups.
CONCLUSION
The incidence of PONV remains high despite most patients receiving 3 prophylactic antiemetic medications. Perphenazine can be considered a cost effective alternative as there was no significant difference in the effectiveness for oral aprepitant or perphenazine for prophylaxis of PONV in patients undergoing CRS within an ERP.
Key Words: Postoperative nausea and vomiting; Colorectal surgery; Colectomy; Enhanced recovery; Aprepitant; Perphenazine
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