Background Postoperative nausea and vomiting (PONV) that occurs after general anaesthesia is frequent and can lead to fatal complications during surgery. The incidence of PONV is approximately 30% and may reach 80% in high risk patients.

Purpose Comparison of the efficacy and tolerability of the combination of aprepitant and dexamethasone versus the combination of droperidol and dexamethasone in reducing the incidence of PONV in patients with a high risk of developing PONV according to the Apfel score.

Material and methods This was a comparative, prospective, randomised, double blind study. After written informed consent, patients scheduled for otorhinolaryngology or visceral surgery under standardised general anaesthesia were randomly assigned to receive a capsule of oral aprepitant 40 mg or a capsule of placebo 1 hour before induction of anaesthesia, and an injection of saline solution as placebo or an injection of 1.25 mg droperidol (IV) at the end of the surgery, respectively. All patients received 4 mg of dexamethasone (IV) after induction of anaesthesia. At multiple time points after surgery (2, 6, 24 and 48 hours), episodes of nausea and vomiting, nausea severity, based on a 0 to 10 point numeric rating score, and the need for rescue medication were recorded.

Results 72 patients completed the study. The cumulative incidence of nausea at 48 hours was 41.9% in the aprepitant group and 43.9% in the droperidol group (p=0.02). The cumulative incidence of vomiting at 48 hours was 16.1% in the aprepitant group and 14.6% in the droperidol group (p=0.03). From 0 to 48 hours, there was no difference between the aprepitant and droperidol groups in the need for rescue antiemetic (metoclopramide; 12.9% vs 12.1%).

Conclusion The combination of droperidol and dexamethasone was more effective than the combination of aprepitant and dexamethasone for prophylaxis against postoperative vomiting in adult patients under general anaesthesia. However, it was less effective for prophylaxis of postoperative nausea. There was no difference between the groups in the need for rescue antiemetic.

No conflict of interest