Background

Post-operative nausea is common following bariatric surgery, particularly laparoscopic sleeve gastrectomy, despite the use of enhanced recovery protocols for perioperative care. In our study we assessed the efficacy of pre-operative aprepitant as an anti-emetic agent for patients undergoing laparoscopic sleeve gastrectomy.

Methods

A single-center retrospective study was conducted. Beginning September 2022, 80 mg of oral aprepitant was added to a standard prophylactic antiemetic regimen, which included scopolamine, dexamethasone, and ondansetron. Utilizing an existing database at our institution, we reviewed the records of patients who underwent laparoscopic sleeve gastrectomy before and after the addition of aprepitant to the standard prophylactic antiemetic regimen. We assessed the severity and frequency of post-operative nausea and vomiting qualitatively (endorsed in postoperative-day-one house-staff note) and quantitatively (number of post-operative antiemetic doses administered beyond standard protocol).

Results

One-hundred-and-thirty-five laparoscopic sleeve gastrectomies were performed between March and November 2022. Sixty-five patients received aprepitant preoperatively, while seventy did not. Groups were similar in age, BMI, and ASA class. In the aprepitant group, we noted a 41.60% reduction in nausea reported on post-operative-day-one (29.20% vs 50.00%, P=0.0133) and a 30.36% reduction in absolute number of additional antiemetic doses (2.98 vs 4.29, P= 0.042). Additional antiemetics included ondansetron, metoclopramide, prochlorperazine, diphenhydramine, haloperidol, and lorazepam. Length of stay was not significantly different (1.32 vs 1.41 days, P=0.416).

Conclusions

The addition of pre-operative aprepitant to a multimodal protocol can reduce nausea after laparoscopic sleeve gastrectomy. Further study will focus on refining such protocol and addressing those who remain significantly nauseated post-operatively.