{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:41:44Z","timestamp":1789177304482,"version":"build-2803163510"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24\u201348-h postoperative period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_106_24","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T03:02:10Z","timestamp":1723777330000},"page":"762-775","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis"],"prefix":"10.4103","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0295-3262","authenticated-orcid":false,"given":"Madhusudan P.","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4862-4264","authenticated-orcid":false,"given":"Meenalotchini P.","family":"Gurunthalingam","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4608-4949","authenticated-orcid":false,"given":"Ayushee","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, RSDKS GMC Ambikapur, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6655-2259","authenticated-orcid":false,"given":"Juhi","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pathology, K.D. Medical College, Mathura, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"key":"R1-20260426","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/ACO.0000000000001063","article-title":"Management of postoperative nausea and vomiting in adults: Current controversies","volume":"34","author":"Rajan","year":"2021","journal-title":"Curr Opin Anaesthesiol"},{"key":"R2-20260426","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4103\/sja.SJA_401_19","article-title":"Prevalence of postoperative nausea and vomiting: A systematic review and meta-analysis","volume":"14","author":"Amirshahi","year":"2020","journal-title":"Saudi J Anaesth"},{"key":"R3-20260426","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1185\/030079906X104830","article-title":"Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: A retrospective database analysis","volume":"22","author":"Habib","year":"2006","journal-title":"Curr Med Res Opin"},{"key":"R4-20260426","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1093\/bja\/aes276","article-title":"Evidence-based analysis of risk factors for postoperative nausea and vomiting","volume":"109","author":"Apfel","year":"2012","journal-title":"Br J Anaesth"},{"key":"R5-20260426","first-page":"CD012859","article-title":"Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: A network meta-analysis","volume":"10","author":"Weibel","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"R6-20260426","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s40265-021-01532-y","article-title":"Neurokinin-1 antagonists for postoperative nausea and vomiting","volume":"81","author":"Jin","year":"2021","journal-title":"Drugs"},{"key":"R7-20260426","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/EJA.0000000000000242","article-title":"Aprepitant for antiemesis after laparoscopic gynaecological surgery: A randomised controlled trial","volume":"33","author":"Ham","year":"2016","journal-title":"Eur J Anaesthesiol"},{"key":"R8-20260426","doi-asserted-by":"crossref","first-page":"e241132","DOI":"10.1136\/bcr-2020-241132","article-title":"Highly effective use of aprepitant in an adolescent girl with severe cyclic vomiting syndrome","volume":"14","author":"Nivatsi","year":"2021","journal-title":"BMJ Case Rep"},{"key":"R9-20260426","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth Analg"},{"key":"R10-20260426","doi-asserted-by":"crossref","first-page":"440","DOI":"10.4097\/kja.d.18.00011","article-title":"Aprepitant in combination with palonosetron for the prevention of postoperative nausea and vomiting in female patients using intravenous patient-controlled analgesia","volume":"71","author":"Yoo","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"R11-20260426","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1111\/aas.13064","article-title":"Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: A double-blind, randomized trial","volume":"62","author":"de Morais","year":"2018","journal-title":"Acta Anaesthesiol Scand"},{"key":"R12-20260426","doi-asserted-by":"crossref","first-page":"e1688","DOI":"10.6061\/clinics\/2020\/e1688","article-title":"Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: A double blind, randomized trial","volume":"75","author":"Grigio","year":"2020","journal-title":"Clinics (Sao Paulo)"},{"key":"R13-20260426","doi-asserted-by":"crossref","first-page":"4250","DOI":"10.1007\/s11695-020-04795-8","article-title":"A comprehensive approach for the prevention of nausea and vomiting following sleeve gastrectomy: A randomized controlled trial","volume":"30","author":"Spaniolas","year":"2020","journal-title":"Obes Surg"},{"key":"R14-20260426","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"R15-20260426","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R16-20260426","article-title":"Identifying and measuring heterogeneity"},{"key":"R17-20260426","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. 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