術後の嘔気・嘔吐 : 選択的ニューロキニン１受容体拮抗薬が及ぼす影響

Post-operative nausea and vomiting（PONV）remains the most frequently reported patients complaint after anesthesia, and for patients, it is of greater concern than postoperative pain. PONV has four main risk factors including : female gender, history of PONV or motion sickness, nonsmoking, and the use of postoperative opioids. Primary control of nausea and vomiting arises from the central pattern generator for vomiting located in the medulla oblongara.
Traditionally, the most common anti-emetics used to treat PONV include serotonin ５-hydroxytryptamine type３antagonists such as ondansetron, corticosteroids, like dexamethasone, or droperidol, which is a neuroleptic. However, these anti-emetics are not completely reliable and only reduce the incidence of PONV by～２６％. Adding additional anti-emetics could further lower the incidence of PONV.
PONV can result in several post-surgical complications. Neurokinin-１（NK-１）receptors are found in gastrointenstinal vagal afferents and within the central nervous system vomiting reflex pathways. NK-１receptors are activated by Substance P, which is a regulatory peptide and preferred endogenous ligand.
We investigated whether NK-１antagonism can effectively diminish PONV in patients undergoing laparoscopic gynecological surgery. Forty two patients were randomized into two groups : NK-１ group which received an oral NK-１antagonist, aprepitant at８０mg, and a control that did not receive any anti-emetic. PONV incidence at２hours was present in both control and NK-１groups and was ８１％ and５２％, respectively. At２４hours PONV was present in the control group, but was absent in the NK１group（２７％ and０％，respectively）.
PONV is associated with dissatisfaction after anesthesia and surgery, can result in several postsurgical complications. NK-１receptor antagonism effectively lowered PONV, and expedited recovery in patients undergoing laparoscopic gynecological surgery.

四国医学雑誌 : http://www.med.tokushima-u.ac.jp/article/0012780.html