TITLE: Comparing the efficacy of oral aprepitant&injection ondansetron for the prevention of post operative nausea and vomiting (PONV) - a double blinded RCT in patients undergoing mastectomy/thyroidectomy

OBJECTIVES: Comparing the antiemetic efficacy of ondansetron and aprepitant in female patients undergoing mastectomy / thyroidectomy

ASA 1 and 2 women, aged 18 to 65 years scheduled for thyroidectomy / mastectomy were randomised for the study. On the day of surgery, patients receivedeither capsule aprepitant 40 mg along with premedication or injection ondansetron 8 mg IV 3 doses Q8h post operatively. The incidence of PONV werecompared using chi square test. The severity of nauseawas compared using Mann-Whitney non parametric test.

Most patients in ondansetron group (n=59) and aprepitant group (n=61) did not have vomiting at 0-2 hours (79.7 vs 85.2%), 2-12 hours (86.4% vs 85.2%) and 12- 24 hours (100% vs 95.1%) postoperatively. Theincidence of vomiting in the ondansetron and aprepitant group at 0-2 hours (20.4% vs 16.4%), 2-12 hours ( 13.6% vs 14.7%) and 12-24 hours (0% vs 4.9%) was not significant between the 2 groups. The nausea severity, number of emetic episodes, time to first emesisand the use of rescue antiemetics were comparable in both groups.

A single dose of oral aprepitant has comparable effects to 3 doses of injectionondansetron administered Q8h in preventing PONV in the first postoperative day.This can also be used in day care surgeries thus avoiding the need for IV injection for 24 hours.