The Impact of Aprepitant on Post‐Operative Nausea and Vomiting in Endoscopic Skull Base Surgery

ABSTRACT Objective Post‐operative nausea and vomiting (PONV) is common following endoscopic skull base surgery despite multimodal prophylaxis and carries a risk of post‐operative bleeding and cerebrospinal fluid (CSF) leakage. This study aims to investigate if pre‐operative administration of the neurokinin‐1 (NK‐1) antagonist, aprepitant, reduces PONV in patients undergoing endoscopic skull base surgery. Methods A retrospective review of 58 patients undergoing endoscopic skull base surgery was performed. Demographic variables and clinical variables such as anesthesia type, procedural time, intraoperative CSF leak, and co‐administration of other antiemetics were collected. Primary outcome was PONV events, defined as the documentation of nausea and/or vomiting in the medical record or use of rescue antiemetic therapy. Post‐operative bleeding and CSF leaks were recorded. Univariate and multivariate analyses were conducted in R with the following covariates: co‐administered antiemetics, TIVA use, smoking status, ASA score, procedural duration, and intraoperative CSF leak. Results Of patients who received aprepitant, 42.9% developed PONV compared to 43.2% in the non‐aprepitant group. On univariate analysis, there was no difference in PONV (OR 0.98, p = 1.00), vomiting (OR 0.33, p = 0.30), or post‐operative bleeding (OR 0.87, p = 1.00) between groups. Multivariate regression showed no association between PONV and aprepitant (OR 0.52, p = 0.32). Subgroup analysis of patients undergoing transsphenoidal surgery showed no association of PONV and aprepitant (OR 0.45, p = 0.34). Conclusion PONV occurs in nearly half of patients undergoing endonasal skull base surgery. Pre‐operative administration of aprepitant was not associated with reduced risk of developing PONV. Level of Evidence 3.