Multi-drug therapy can benefit patients at higher risk for post-operative nausea and vomiting

American Society of Anesthesiologists (ASA)Oct 14 2013

Ninety-seven percent of bariatric surgery patients avoided post-operative nausea and vomiting (PONV) with the addition of a second drug to the standard treatment given during surgery, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting.

"Nausea and vomiting are some of the most common post-op complications for all patients who have general anesthesia," said Ashish C. Sinha, M.D., Ph.D., vice chair of anesthesiology and perioperative medicine at Drexel University College of Medicine, Philadelphia. "However after weight-loss surgery, the consequences of vomiting can be very serious. During this kind of surgery, the stomach is transformed to a small, one-ounce sac. Vomiting risks rupturing the fresh incision as the contents of the stomach try to violently exit the narrow, freshly created stomach pouch. Reducing this risk would mean more comfortable patients as well as safer surgery and anesthesia."

An estimated 113,000 people in the United States have bariatric weight-loss surgery annually, according to the American Journal of Surgery. Approximately 15 million, or one in 50 American adults, are morbidly obese, which is associated with more than 30 diseases and conditions, including type 2 diabetes, heart disease, obstructive sleep apnea, hypertension, asthma, cancer, osteoarthritis and infertility. The direct and indirect costs to the health care system associated with obesity are about $147 billion annually, according to the American Society for Metabolic and Bariatric Surgery. These costs are expected to increase to $344 billion in five years, if obesity rates continue to increase at the current pace.

The study included 124 patients. Within one hour of the anticipated start of anesthesia, 64 people received the combination treatment of Zofran (the standard therapy) plus aprepitant; the remaining 60 patients got the Zofran and a placebo. Nausea was assessed with a 10-point scale after surgery at intervals of 30 minutes, one, two, six, 24 , 48 and 72 hours.

The study found that only three percent of patients who received the combination treatment experienced PONV. The incidence of vomiting was 15 percent in the placebo group who received Zofran alone.

"This multi-drug therapy can benefit patients at higher risk for PONV," continued Dr. Sinha. "There are multiple receptors in the brain stem that trigger vomiting; if we use the combination therapy, we can increase the number of receptors blocked and lower the incidence of vomiting."