Comparison of single-dose oral aprepitant and intravenous ondansetron for the prevention of post-operative nausea and vomiting in patients undergoing open abdominal surgery

Background: Post-operative nausea and vomiting (PONV) remains one of the most common and distressing complications following general anesthesia, particularly after open abdominal surgery. Despite the widespread use of 5-HT₃ receptor antagonists such as ondansetron, the incidence of PONV remains significant. Aprepitant, a neurokinin-1 receptor antagonist, has emerged as an effective alternative for PONV prophylaxis. Aims and Objectives: To compare the efficacy of single-dose oral aprepitant with intravenous ondansetron for the prevention of PONV in patients undergoing open abdominal surgery under general anesthesia. Materials and Methods: This prospective comparative study was conducted over a 2-year period at a tertiary care center. A total of 249 adult patients undergoing open abdominal surgery under general anesthesia were allocated to three groups. Group A received intravenous ondansetron 4 mg at induction. Group B was administered oral aprepitant 40 mg, and Group C received oral aprepitant 125 mg, both given 3 h prior to induction. The incidence and severity of PONV, requirement of rescue antiemetics, and adverse effects were assessed over a 24-h post-operative period. Results: The incidence of PONV was significantly lower in patients receiving oral aprepitant (both 40 mg and 125 mg) compared with those receiving intravenous ondansetron. No statistically significant difference was observed between the two aprepitant dose groups. The requirement for rescue antiemetics and the incidence of adverse effects were comparable among the three groups. Conclusion: Pre-operative administration of a single oral dose of aprepitant is more effective than intravenous ondansetron in preventing PONV among patients undergoing open abdominal surgery, while maintaining a comparable safety profile.