Fosaprepitant versus droperidol for prevention of PONV in craniotomy: a randomized double-blind study

Postoperative nausea and vomiting (PONV) is a common complication after craniotomy. Vomiting may be a potentially hazardous complication in neurosurgical patients. We compared the efficacy of fosaprepitant and droperidol for the prevention of PONV, vomiting in particular, after craniotomy. Patients scheduled to undergo elective craniotomy were enrolled in the study and randomly divided in a double-blind manner into two groups to receive either 150 mg of fosaprepitant (group F) or 1.25 mg of droperidol (group D). Dexamethasone (9.9 mg) was given to all patients, except those with diabetes mellitus. The incidence of PONV, frequency of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery were assessed at five time intervals (0-2, 2-6, 6-24, 24-48, and 48-72 h). Of the 200 randomized patients eligible for entry into the study, 186 were ultimately included for analysis. There were no significant differences in demographics or intraoperative variables between the two treatment groups. Over the entire 72-h post-craniotomy observation period the overall and cumulative incidence of vomiting was significantly lower in group F patients than in group D patients, while there were no between-group differences in the overall and cumulative incidence of PONV or in complete response (no PONV and no rescue antiemetic). The incidence and frequency of vomiting during each of the five observational periods were significantly lower in group F patients than group D patients, although there were no differences in the nausea score and antiemetic use between the groups. Based on the results, fosaprepitant was more effective than droperidol in the prevention of vomiting after craniotomy over the entire 72-h study period. However, there was no difference in the incidence of nausea and antiemetic use.