Effects of aprepitant /dexamethasone versus mirtazapine/dexamethasone on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial

Background: Co-administration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) following laparoscopic sleeve gastrectomy (LSG). The investigators compared the combination of aprepitant and dexamethasone (A/D) with the combination of mirtazapine and dexamethasone (M/D) for prevention of PONV in morbidly obese patients undergoing LSG. Methods Ninety patients scheduled for LSG were assigned to receive a single preoperative dose of dexamethasone 8 mg IVI (D group), and in addition to oral aprepitant 80 mg (A/D group) or oral mirtazapine 30 mg (M/D group) in a randomized, double-blind trial. Assessment of PONV was done 0–2 h (early) and 2–24 hours (late). Patients’ level of sedation, satisfaction and postoperative pain were also assessed. Results A/D and M/D groups were superior to D group for complete response 0–24 h after surgery (79.3% for A/D group, 78.6% for M/D group and 20.7% for D group). D group was inferior to A/D and M/D groups regarding collective PONV and use of rescue antiemetics (P < 0.001) 0–24 h after surgery. The peak nausea scores 2–24 h were significantly lower in both A/D and M/D groups vs. D group (P = 0.005). Patients in the M/D group showed higher sedation scores while those in A/D groups showed lower pain scores and less analgesic requirements. A/D and M/D groups were superior to D group regarding the patient’s satisfaction score. Conclusion A/D and M/D combinations were superior to D alone regarding the proportion of patients exhibiting a complete response in preventing PONV associated with LSG. Trial Registration: Clinical Trials. gov Identifier: NCT04013386/ prospectively registered: 09/07/2019, http://www.Clinical Trial.gov