Comparison of Aprepitant, Dexamethasone and Ondansetron with Dexamethasone and Ondansetron for prevention of post operative nausea vomiting in high risk patients undergoing laparoscopic surgeries. A Randomised control trial.

POST-OPERATIVE NAUSEA VOMITING OCCUR IN UPTO 30% OF ALL SURGICAL PATIENTS 70 - 80% OF HIGH RISK PATIENTS FOLLOWING SURGERY WITH NO PROPHYLACTIC ANTIEMETIC THERAPY. PONV CAN RESULT IN NUMEROUS ADVERSE EVENTS INCLUDING FLUID IMBALANCES, WOUND DEHISCENCE, ESOPHAGEAL TEARS AND RAISED INTRACRANIAL PRESSURE. IT INCREASES PATIENTS DISCOMFORT AS WELL AS DELAYS RECOVERY AND DISCHARGE RESULTING IN INCREASED HEALTH CARE COSTS. FEMALE SEX, YOUNGER AGE, NON SMOKING STATUS, POST-OPERATIVE OPOID ANALGESIA AND HISTORY OF MOTION SICKNESS ARE RISK FACTORS FOR PONV. THIS STUDY AIMS AT COMPARING THE INCIDENCES OF PONV AFTER TRIPLE DRUG PROPHYLAXIS (GROUP A) WITH APREPITANT 80MG, DEXAMETHASONE 8MG AND ONDANSETRON 4MG AS COMPARED TO THE ROUTINELY USED PROPHYLAXIS (GROUP C) WITH 8MG DEXAMETHASONE AND 4MG ONDANSETRON. FEMALES >18YRS, NON SMOKERS UNDERGOING LAPAROSCOPIC SURGERY LASTING 2-4 HOURS, RECEIVING INTRAOPERATIVE AND POSTOPERATIVE OPOID ANALGESIA WILL BE GIVEN APREPITANT 80MG IN GROUP A  ( 82 PARTICIPANTS) AND  PLACEBO IN GROUP C (82 PARTICIPANTS) 2HRS BEFORE THE SURGERY. PATIENTS WILL BE FOLLOWED UP AT TWO POINTS- 2HRS AND 24HRS AFTER SURGERY FOR THE INCIDENCE OF NAUSEA AND VOMITING (PRIMARY OUTCOME). THE SECONDARY OUTCOME WILL BE THE TIME TO FIRST RESCUE ANTIEMETIC AND AMOUNT CONSUMED IN FIRST 24 HOURS. TO QUANTIFY SYMPTOMS A PONV SCALE WILL BE USED. A PONV IMPACT SCALE SCORE OF MORE THAN OR EQUAL TO 5 WILL BE CONSIDERED CLINICALLY IMPORTANT PONV.