Comparative Study Between Fosaprepitant and Palonosetron in the Prophylaxis of Postoperative Nausea and Vomiting in Women Undergoing Laparoscopic Cholecystectomy: Prospective, Randomized and Double-Blind Study

CYP2D6 isoenzyme and ABCB1 gene polymorphisms associated with postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy: a randomized trial

INTRODUCTION

Postoperative nausea and vomiting is still a common complication. Serotonin receptor antagonists are commonly used in clinical practice for antiemetic prophylaxis. Interindividual variations in drug response, including single nucleotide polymorphisms, are related to pharmacokinetic and pharmacodynamic changes in these drugs and may lead to a poor therapeutic response. This study aimed to evaluate the influence of CYP2D6 isoenzyme and ABCB1 gene polymorphisms on the frequency of postoperative nausea and vomiting with the use of ondansetron or palonosetron.

METHODS

A randomized, double-blind clinical trial including 82 women aged 60 years or over undergoing laparoscopic cholecystectomy was conducted. Patients were randomized to receive either ondansetron or palonosetron for postoperative nausea and vomiting prophylaxis. DNA was extracted from saliva. Genetic polymorphisms were analyzed by real-time polymerase chain reaction. The following polymorphisms were analyzed: rs3892097 C/T, rs1128503 A/G, rs16947 A/G, rs1065852 A/G, rs1045642 A/G, rs2032582 C/A, and rs20325821 C/A.

RESULTS

Overall, vomiting, and severe nausea occurred in 22.5% and 57.5% of patients, respectively. In the palonosetron group, patients with the GG genotype (rs16947 A/G) experienced more severe nausea (p = 0.043). In the ondansetron group, patients with the AA genotype (rs16947 A/G) presented mild nausea (p = 0.034), and those with the AA genotype (rs1065852 A/G) experienced more vomiting (p = 0.034).

CONCLUSION

A low antiemetic response was observed with ondansetron in the presence of the AA genotype (rs16947 A/G) and the AA genotype (rs1065852 A/G), and a low therapeutic response was found with palonosetron in the presence of the GG genotype (rs16947 A/G) in laparoscopic cholecystectomy.

REGISTER

ClinicalTrials.gov.

The Efficacy of Acupressure for Nausea and Vomiting After Laparoscopic Cholecystectomy: A Meta-analysis Study

OBJECTIVES

This meta-analysis aims to explore the impact of acupressure on nausea and vomiting for patients undergoing laparoscopic cholecystectomy (LC).

BACKGROUND

Acupressure may have some potential in managing nausea and vomiting after LC.

PATIENTS AND METHODS

PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of acupressure on nausea and vomiting for LC.

RESULTS

Six randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for LC, acupressure was associated with significantly reduced incidence of nausea at 2 hours [odds ratio (OR) = 0.37; 95% CI = 0.21-0.67; P = 0.001] and nausea at 6 hours (OR = 0.38; 95% CI = 0.22-0.66; P = 0.0006; Fig. 4), and decreased need of rescue antiemetic (OR = 0.41; 95% CI = 0.20-0.85; P = 0.02; Fig. 8), but demonstrated no obvious impact on vomiting at 2 hours (OR = 0.76; 95% CI = 0.28-2.10; P = 0.60), vomiting at 6 hours (OR = 0.49, 95% CI = 0.20-1.20; P = 0.12), nausea at 24 hours (OR = 0.71; 95% CI = 0.37-1.35; P = 0.30), or vomiting at 24 hours (OR = 0.81; 95% CI = 0.28-2.35; P = 0.69).

CONCLUSIONS

Acupressure is effective in controlling nausea and decreasing rescue antiemetics for LC.