Antiemetic activity of Fosaprepitant as a rescue agent in patients with postoperative nausea and vomiting after orthopedic surgery

Abstract Background: Postoperative nausea and vomiting (PONV) is a common postoperative complication in the orthopedic surgical setting which may result in significant consequences. Many agents exist for PONV prophylaxis but rescue options remains a big challenge. Fosaprepitant has been studied in PONV prophylaxis but‘evidence for use of neurokinin-1 receptor antagonists (NK-1 RA) for PONV rescue is lacking. Assessing fosaprepirant as a rescue agent for PONV in the orthopedic surgical population was warranted. Methods: In this single center retrospecitve chart review, the antiemetic activity of fosaprepitant (selective NK1 receptor antagonist) was investigated as a rescue agent for PONV in patients undergoing orthopedic surgery. Based on the institutional protocol, fosaprepitant was only utilized in patients who experienced PONV with an existing history of PONV or when 2 antiemtic agents were exhausted with no success in the postoperative period. Chart reviews, progress notes, electronic message requests, pyxis medication removal reports and clinical interventions were utilized to assess emesis relief. The primary outcome was to assess fosprepipant’s effect as a rescue agent for PONV in the orthopedic surgical setting. Results: A total of 383 patients (over a 12 month period) were approved based on the hospital protocol to receive fosaprepitant as a rescue agent. Out of the 383 patients, 286 had relief with fosaprepitant, with 196 patients not requiring further antiemetic therapy. Patient demographs, anesthesia type, additional medications and surgical types were all assessed thoroughly. Three of the surgical types showed the potential significance for fosaprepirtant PONV relief: Sports management and shoulder 81% (p = 0.0012), Adult Reconstruction and Joint Replacement 78% (<0.0001), Spine 66% (p = 0.015), Conclusion: The data shows their may be potential for utilizing fosaprepitant as a rescue agent for PONV in the orthopedic setting. A bigger study with a larger sample size is encouraged.