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

Backgroud: Postoperative nausea and vomiting (PONV) is a common postoperative complication in the surgical setting. Many agents exist for PONV prophylaxis but rescue options remains a big challenge. Fosaprepitant has been studied in PONV prophylaxis but the data is limited when utilized for rescue. 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 with an existing history of PONV or when 2 antiemtic agents were exhausted with no success in the postoperative period. The groups evaluated are inferred to be patients with and without emesis relief. Chart reviews, progress notes and clinical interventions were utilized to assess emesis relief. Results: 383 total patients (over a 12 month period) fell into the hospital protocol and approved to receive fosaprepitant as a rescue agent. Out of the 383 patients, 286 had relief with fosaprepitant, and 196 patients did not require further antiemetic therapy. Patient demographs, anesthesia type, additional medications and surgical types were all assessed thoroughly. Three surgical types showed the most prominent significance for fosaprepirtant PONV relief: Sports management and shoulder 76% (p = 0.0012). Adult Reconstruction and Joint Replacement 74% (<0.0001), Spine 61% (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 warranted.