Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay
Background: Significant postoperative nausea and vomiting (PONV) in pediatric patients undergoing posterior spinal fusion is common and limits recovery, prolonging hospital stay. Fosaprepitant is a long-acting antiemetic and works by blocking substance P binding to the neurokinin-1 (NK1) receptor. T...
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Elsevier
2025-05-01
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| Series: | Journal of the Pediatric Orthopaedic Society of North America |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2768276525000185 |
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| author | Jennifer Busse Aaron Louie Jennifer Crotty Albert Lin Zarema Muratova Matan Malka Ritt Givens Benjamin Roye Michael Vitale William Schechter |
| author_facet | Jennifer Busse Aaron Louie Jennifer Crotty Albert Lin Zarema Muratova Matan Malka Ritt Givens Benjamin Roye Michael Vitale William Schechter |
| author_sort | Jennifer Busse |
| collection | DOAJ |
| description | Background: Significant postoperative nausea and vomiting (PONV) in pediatric patients undergoing posterior spinal fusion is common and limits recovery, prolonging hospital stay. Fosaprepitant is a long-acting antiemetic and works by blocking substance P binding to the neurokinin-1 (NK1) receptor. There is evidence that its perioperative use substantially reduces PONV in adults, but there is a dearth of literature on its use in pediatric PONV. We seek to elucidate whether a postoperative dose of fosaprepitant in pediatric posterior instrumentation and fusion (PSIF) patients decreases PONV, thus improving recovery and decreasing the length of hospital stay. Methods: This is a retrospective chart review of 173 pediatric patients with idiopathic scoliosis undergoing PSIF. The anesthetic methodology was standardized among both groups. The cohort was divided into two groups according to the use of fosaprepitant intraoperatively (or within four hours postoperatively) or no use. We examined patient characteristics, fosaprepitant dose, incidence of PONV, time to transition from parenteral to oral opioids, and length of hospital stay. Results: 78 (45%) patients received fosaprepitant and 95 (55%) did not. There were no statistically significant differences between groups based on demographics or intraoperative management. No significant difference was found in the incidence of PONV between the groups, but there was a reduction in the number of rescue antiemetics required and a quicker transition from parenteral to oral opioids in the fosaprepitant group. There was also a significantly decreased length of stay. Conclusions: While fosaprepitant did not significantly decrease PONV in pediatric PSIF patients, it was associated with decreased use of additional antiemetics. The patients also demonstrated a more rapid transition to oral from parenteral opioids and a shorter length of hospital stay. A larger study may show a statistically significant reduction in PONV in patients who received fosaprepitant. Future studies are needed to elucidate the optimal dose and timing needed to treat PONV in pediatrics. Key Concepts: (1) Spinal fusion surgery patients are at risk of having significant postoperative nausea and vomiting. (2) Fosaprepitant is an effective agent to treat postoperative nausea and vomiting in adults, but has not been extensively studied in pediatrics for this purpose. Level of Evidence: The level of evidence is a 3 as it is a cohort study looking at the relationship between an exposure and an outcome. |
| format | Article |
| id | doaj-art-9b6dedb1b3ce4c5e8de8e67dd297c1c1 |
| institution | DOAJ |
| issn | 2768-2765 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Pediatric Orthopaedic Society of North America |
| spelling | doaj-art-9b6dedb1b3ce4c5e8de8e67dd297c1c12025-08-20T02:57:05ZengElsevierJournal of the Pediatric Orthopaedic Society of North America2768-27652025-05-011110017410.1016/j.jposna.2025.100174Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of StayJennifer Busse0Aaron Louie1Jennifer Crotty2Albert Lin3Zarema Muratova4Matan Malka5Ritt Givens6Benjamin Roye7Michael Vitale8William Schechter9Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA; Corresponding author: Columbia University, 622 West 168th Street, New York, NY 10032, USA.Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USADepartment of Orthopedics, Columbia University Irving Medical Center, New York, NY, USADepartment of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USADepartment of Pharmacy, Columbia University Irving Medical Center, New York, NY, USADepartment of Orthopedics, Columbia University Irving Medical Center, New York, NY, USADepartment of Orthopedics, Columbia University Irving Medical Center, New York, NY, USADepartment of Orthopedics, Columbia University Irving Medical Center, New York, NY, USADepartment of Orthopedics, Columbia University Irving Medical Center, New York, NY, USADepartment of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USABackground: Significant postoperative nausea and vomiting (PONV) in pediatric patients undergoing posterior spinal fusion is common and limits recovery, prolonging hospital stay. Fosaprepitant is a long-acting antiemetic and works by blocking substance P binding to the neurokinin-1 (NK1) receptor. There is evidence that its perioperative use substantially reduces PONV in adults, but there is a dearth of literature on its use in pediatric PONV. We seek to elucidate whether a postoperative dose of fosaprepitant in pediatric posterior instrumentation and fusion (PSIF) patients decreases PONV, thus improving recovery and decreasing the length of hospital stay. Methods: This is a retrospective chart review of 173 pediatric patients with idiopathic scoliosis undergoing PSIF. The anesthetic methodology was standardized among both groups. The cohort was divided into two groups according to the use of fosaprepitant intraoperatively (or within four hours postoperatively) or no use. We examined patient characteristics, fosaprepitant dose, incidence of PONV, time to transition from parenteral to oral opioids, and length of hospital stay. Results: 78 (45%) patients received fosaprepitant and 95 (55%) did not. There were no statistically significant differences between groups based on demographics or intraoperative management. No significant difference was found in the incidence of PONV between the groups, but there was a reduction in the number of rescue antiemetics required and a quicker transition from parenteral to oral opioids in the fosaprepitant group. There was also a significantly decreased length of stay. Conclusions: While fosaprepitant did not significantly decrease PONV in pediatric PSIF patients, it was associated with decreased use of additional antiemetics. The patients also demonstrated a more rapid transition to oral from parenteral opioids and a shorter length of hospital stay. A larger study may show a statistically significant reduction in PONV in patients who received fosaprepitant. Future studies are needed to elucidate the optimal dose and timing needed to treat PONV in pediatrics. Key Concepts: (1) Spinal fusion surgery patients are at risk of having significant postoperative nausea and vomiting. (2) Fosaprepitant is an effective agent to treat postoperative nausea and vomiting in adults, but has not been extensively studied in pediatrics for this purpose. Level of Evidence: The level of evidence is a 3 as it is a cohort study looking at the relationship between an exposure and an outcome.http://www.sciencedirect.com/science/article/pii/S2768276525000185PediatricsSpinal fusionPostoperative nausea and vomitingLength of stay |
| spellingShingle | Jennifer Busse Aaron Louie Jennifer Crotty Albert Lin Zarema Muratova Matan Malka Ritt Givens Benjamin Roye Michael Vitale William Schechter Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay Journal of the Pediatric Orthopaedic Society of North America Pediatrics Spinal fusion Postoperative nausea and vomiting Length of stay |
| title | Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay |
| title_full | Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay |
| title_fullStr | Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay |
| title_full_unstemmed | Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay |
| title_short | Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay |
| title_sort | fosaprepitant use as an antiemetic to prevent postoperative nausea and vomiting in pediatric spinal fusion patients may be associated with more rapid transition to oral pain medication and reduced length of stay |
| topic | Pediatrics Spinal fusion Postoperative nausea and vomiting Length of stay |
| url | http://www.sciencedirect.com/science/article/pii/S2768276525000185 |
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