Comparison of the effects of Aprepitant and Dexamethasone on postoperative nausea and vomiting after laparoscopic cholecystectomy: A double blind randomised trial.

Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications (Myles et al. 2000). It is caused by various factors such as the use of anaesthetics, perioperative use of opioids, the type of surgery, and patient characteristics (Apfel et al. 2003). PONV decreases overall patient satisfaction and is associated with poor surgical outcomes. It extends the hospitalisation period because of delayed recovery and causes fatal complications such as suture laceration, bleeding, increased intracranial pressure, aspiration pneumonia, dehydration and electrolyte imbalance (Gan et al. 2003).

Various classes of medications, including serotonin receptor antagonists and dopamine receptor antagonists are currently used to prevent PONV in patients undergoing laparoscopic cholecystectomy. However, due to increased intra-abdominal pressure during laparoscopy and perioperative use opioids, the risk of PONV increases (Bradshaw et al . 2002). Even after the use of recommended drugs for PONV prophylaxis, patient experiences significant amount of postoperative nausea and vomiting after laparoscopic cholecystectomy.

Aprepitant is a neurokinin-1 receptor antagonist that blocks the emetic effects of substance P (SP) at neurokinin-1 receptors in the gastrointestinal tract. It also inhibits the signals received from the chemoreceptor trigger zone by the nucleus tractus solitarius in the brain stem *(Diemunsch et al. 2009).*Aprepitant has been used to prevent chemotherapy-induced nausea and vomiting. However, its efficacy in PONV prevention in non-chemotherapy patients and elective surgeries is still unexplored.

 In previous literatures, the evidences for analgesic property of Aprepitant are few and lacking. Therefore, our hypothesis of considering Aprepitant a better alternative for PONV prevention and pain control can change our practice in anaesthesia. Aprepitant may become a part of multimodal analgesia with additional antiemetic property leading to better patient satisfaction and early discharge.

 However, Dexamethasone is well known for its antiemtic and analgesic properties, its comparison with Aprepitant can bring up new evidences for PONV prevention and pain management in patients undergoing laparoscopic cholecystectomy.