Discussion
nausea, postoperative pain, anxiety, cancer, nausea and vomiting, vomiting, pain, hypoxemia, Nausea, PONV, depression, Diemensch
CANCER, ELECTROLYTE DISTURBANCE, COMPLICATIONS, COMPLICATION
Advancements in surgical techniques and the development of new anesthesia drugs have significantly reduced the occurrence of severe, life-threatening side effects. However, despite these improvements, the issue of PONV remains a persistent concern and none of the current antiemetic drugs has been able to resolve this simple but important problem.Apipan et al. consider that PONV is the most common complication after orthognathic surgery under general anesthesia. This complication causes a decaying and undesirable feeling, and the occurrence of serious but albeit complications such as aspiration, postoperative hypoxemia, water and electrolyte disturbances, opening of the surgical incision, and delay in the discharge of patients [In a double-blind clinical trial conducted by Salome Jeyabalan et al., the researchers aimed to compare the efficacy of two different treatment regimens in preventing PONV. They divided 120 patients who underwent abdominal or thyroid surgery into two groups. One group received ondansetron along with aprepitant, while the other group received ondansetron with a placebo. The primary outcomes measured were the incidence of nausea and vomiting, as well as the time required for rescue drugs to be administered. They concluded that a single dose of 40 mg of aprepitant had a comparable effect to 8 mg of intravenous ondansetron every 8 h in preventing PONV, the severity of nausea, the number of times rescue medication was requested, and the time of the first nausea attack in 24 h after surgery. The findings of this study about the effectiveness of aprepitant on PONV are similar to our study. However, the design of their study is different from our study because they injected ondansetron in both groups at the end of the operation and then every 8 h, while in our study only one group of patients received ondansetron and the patients in the aprepitant group received distilled water instead of ondansetron [In a randomized double-blind study, Diemensch P et al. compared the effect of two single doses of aprepitant (40 mg and 125 mg) with 4 mg of intravenous ondansetron on the prevention of PONV in 922 patients who underwent general anesthesia for open abdominal surgery. They recorded episodes of vomiting, the use of rescue medication, and the severity of nausea for 48 h. The primary outcome was a complete response (no vomiting and no use of rescue therapy) within 0-24 h of surgery. They concluded that both doses of aprepitant were non-inferior to ondansetron in achieving a complete response in the first 24 h. Aprepitant was significantly more effective than ondansetron in preventing vomiting and reducing nausea in both 24 and 48 h. The findings of our study are consistent with the mentioned study [In a randomized double-blind study, Bergese et al. compared the three drugs of aprepitant, dexamethasone, and promethazine with ondansetron, dexamethasone, and promethazine on declining the incidence of PONV in 176 patients who underwent craniotomy under general anesthesia. The researchers concluded that both triple-drug regimens have a similar effect on the prevention of PONV. The results of this study regarding the superiority of ondansetron over aprepitant are different from our study. The explanation for the discrepancy in the results between our study and the study conducted by Bergese et al. is not entirely clear. However, the differences in patient populations between the two studies, variations in the dosages or administration of two additional drugs (dexamethasone, and promethazine), and differences in study design (sample size, randomization methods, blinding techniques, and outcome measures), may contribute to discrepancies between two studies [Gan TJ et al. in a multicenter study compared the effect of two different doses of oral aprepitant for the prevention of PONV on patients who underwent open abdominal surgery under general anesthesia. In their study, patients divided into three groups. The first and second groups received 40 and 125 mg of oral aprepitant, respectively, and the third group received 4 mg of intravenous ondansetron. The researchers concluded that for the prevention of vomiting in the first 48 h after the operation, aprepitant is superior to ondansetron, but there is no significant difference between aprepitant and ondansetron in controlling nausea, using rescue drugs, and complete response. The results of our study regarding the occurrence of vomiting are consistent with the results of the above study. However, regarding the use of rescue drugs and control of nausea and complete response, the results of this study are inconsistent with our study, which be attributed to the difference in kind of surgery in the patients of the two studies and the possibility of lower chance of complete response and reduction of nausea in open abdominal surgeries [In a randomized double-blind clinical trial, Hassan AME et al. divided 150 patients who underwent laparoscopic bariatric surgery into three groups (50 patients in the ondansetron group (A), 50 patients in the aprepitant group (B), and 50 patients in the ondansetron group + aprepitant [Safarnejad F et al. compared the effect of aprepitant and ondansetron on PONV following laparoscopic cholecystectomy separately and in combination in their study. They divided patients into three groups. The first group received 80 mg of oral aprepitant, the second group received 4 mg of intravenous ondansetron, and the third group received 4 mg of intravenous ondansetron and 80 mg of oral aprepitant. Nausea and vomiting in the third group were less than the other two groups. In addition, the occurrence of vomiting in the first group was significantly lower than in the second group. Results of the mentioned study were consistent with our findings [In a systematic review, Liu et al. reviewed 14 clinical trials about the effects of two doses of 40- and 80-mg of aprepitant on PNOV. According to their systematic review, both doses of aprepitant are more effective than 4 mg of ondansetron in preventing PONV. According to the results of the mentioned studies and the current study, in the first 24 h after the surgery, aprepitant compared to ondansetron significantly reduces the incidence and severity of nausea and vomiting, use of rescue medication, and increases complete response [Kakuta and colleagues in a study investigated the effectiveness of aprepitant on nausea and vomiting, and post-operative pain. They concluded that aprepitant not only reduces nausea and vomiting but also increases pain tolerance. Investigation about postoperative pain was not among our study goals [Aprepitant is traditionally used in the treatment of nausea and vomiting caused by cancer chemotherapy. Recently, it has been observed that aprepitant is effective not only in the treatment of PONV but also in reducing postoperative pain. Substance P is one of the neurotransmitters that is found in both central and peripheral nerves. It has been found that after binding to neurokinin 1 receptors, substance P regulates many biological functions of the central nervous system, such as emotions, negative behaviors, stress, depression, pain, and anxiety. Neurokinin 1 receptor antagonists specifically inhibit some biological functions that mediated by the binding of substance P to neurokinin 1 receptors [