Aprepitant Versus Ondansetron in Preoperative Triple-therapy Treatment of Nausea and Vomiting
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 122
- 试验地点
- 1
- 主要终点
- Proportion of Patients With a Complete Response/Complete Control During the First 24 Hours After Neurological Surgery Under General Anesthesia
研究概览
简要总结
This study is being done to determine the efficacies of two preventative drug combinations for postoperative nausea and vomiting in patients undergoing neurosurgery. The aim of this study is to compare the efficacy of using aprepitant instead of ondansetron in combination with dexamethasone and promethazine for post-operative nausea and vomiting prophylaxis. By completing this comparison study investigators will determine the most efficacious drug combination which will allow us to enhance the overall comfort and satisfaction of neurosurgical patients in the immediate postoperative period.
详细描述
One hundred-seventy-six (200) consecutive patients meeting the inclusion and exclusion criteria and who give written informed consent to participate in the study will be randomly assigned to one of two experimental groups using a 1:1 ratio. Patients in Group I will receive 25mg promethazine given intravenously (IV), 10mg dexamethasone given IV, 4mg ondansetron given intravenously, and a placebo pill given orally. Patients in Group II will receive 25mg promethazine given IV, 10mg dexamethasone given IV, 40mg aprepitant given orally, and an intravenous placebo. Thus all patients receive 25mg promethazine and 10mg dexamethasone. Group I will additionally receive 4mg ondansetron plus placebo PO and Group II will additionally receive 40mg aprepitant plus IV placebo. Because this is a double-blind study and because ondansetron is given intravenously whereas aprepitant is given orally, it is necessary to give patients an oral or IV placebo, depending on their group assignment for uniformity. Thus each patient will receive the three drugs in the PONV prophylactic triple cocktail, plus an IV or oral placebo prior to induction of anesthesia. See table below.
The following demographic and preoperative data about each patient in the two groups will be recorded:
Demographic and Preoperative Data Gender Systolic blood pressure, diastolic blood pressure, median blood pressure Age Smoking history PONV History Motion sickness history Surgery Anesthesia modality CPP Race ECG recording Hepatic function Renal function Past reactions to the study drugs
The duration of each surgery (anesthesia time) will be recorded for each patient. Patients will be continuously monitored in the post anesthesia care unit (PACU), surgical intensive care unit (SICU) and the medical floor for a total of 120 hours post operatively. Episodes of nausea, vomiting and administration of rescue therapy for either nausea or vomiting will be recorded and time stamped. In addition, the severity of the nausea or vomiting will be recorded. Nausea will be evaluated by the patient utilizing a standard verbal response scale (VRS) ranging from 0-10, 0 being no nausea and 10 being severe nausea. Vomiting will be evaluated by the investigator or nursing staff numerically as either 0, no vomiting, 1, mild vomiting, 2, moderate vomiting, or 3, severe vomiting. Rescue therapy for PONV episodes will consist of 4mg ondansetron. After the first 24hrs of starting the triple therapy antiemetic, ECG will be recorded as well as blood drawn for analysis.
Variables Primary Efficacy Variable The percentage of patients with no vomiting over 0-72 hours post operatively across the two treatment groups.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Adult patients
- •18 to 85 years of age
- •Scheduled for neurosurgery requiring opening of the cranium and dura at Ohio State University Medical Center and who consent in writing to participate in this study are eligible.
排除标准
- •Patients will be excluded from this study if they are
- •pregnant women
- •mentally ill
- •under the age of 18 or over the age of 85
- •American Society of Anesthesiologist (ASA) classification V
- •alcohol or drug abusers
- •have a cerebral perfusion pressure (CPP) greater than 150 mmHg or less than 50 mmHg.
研究组 & 干预措施
Aprepitant
Aprepitant is given orally, along with an oral or PO placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy 40mg Aprepitant PO + IV placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Aprepitant (Drug)
Aprepitant
Aprepitant is given orally, along with an oral or PO placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy 40mg Aprepitant PO + IV placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Promethazine (Drug)
Aprepitant
Aprepitant is given orally, along with an oral or PO placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy 40mg Aprepitant PO + IV placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Dexamethasone (Drug)
Ondansetron
Ondansetron is given via IV, along with an oral or IV placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication (25mg promethazine, 10mg dexamethasone, and either 4mg ondansetron or 40mg aprepitant) plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy
4mg Ondansetron IV + PO placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Ondansetron (Drug)
Ondansetron
Ondansetron is given via IV, along with an oral or IV placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication (25mg promethazine, 10mg dexamethasone, and either 4mg ondansetron or 40mg aprepitant) plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy
4mg Ondansetron IV + PO placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Promethazine (Drug)
Ondansetron
Ondansetron is given via IV, along with an oral or IV placebo depending on their group assignment for uniformity. Each patient will receive three drugs in their respective triple prophylactic medication (25mg promethazine, 10mg dexamethasone, and either 4mg ondansetron or 40mg aprepitant) plus an IV or oral placebo prior to induction of anesthesia.
Triple therapy
4mg Ondansetron IV + PO placebo, 25mg Promethazine IV and 10mg dexamethasone IV
干预措施: Dexamethasone (Drug)
结局指标
主要结局
Proportion of Patients With a Complete Response/Complete Control During the First 24 Hours After Neurological Surgery Under General Anesthesia
时间窗: 24 hours post operatively
To assess the efficacy of triple therapy with Scopolamine, Ondansetron and Dexamethasone for prevention of post operative nausea and vomiting (PONV) in high risk patients during the first 24 hours after neurological surgery under general anesthesia. - Proportion of patients with a complete response/complete control during the first 24 hours after neurological surgery under general anesthesia. Complete Control is defined as no emetic episode, no need for rescue medication and no more than mild nausea overall after neurological surgery and general anesthesia. Complete Response is defined as no vomiting and no rescue therapy after neurological surgery and general anesthesia.
次要结局
- Post Operative Nausea and Vomiting (PONV) Scores on a Verbal Response Scale(24 hours post-operatively)
研究者
Sergio Bergese
Associate Professor
Ohio State University