Date of this Version


Document Type

DNP Project


Background: The incidence of postoperative nausea and vomiting (PONV) following general anesthesia remains high despite the increasing number of healthcare advances. Aprepitant has demonstrated promising effectiveness in the prevention of PONV and can add value to current healthcare practices. Further investigation is needed to determine aprepitant’s effectiveness and best use to create practice recommendations.

Objectives: (1) To evaluate the effectiveness of aprepitant versus ondansetron in the prevention of PONV utilizing three databases: PubMed, CINAHL, and EMBASE. This systematic review will serve as the basis for objective two. (2) To demonstrate an increase in knowledge of anesthesia providers pertaining to the use of aprepitant in the prevention of PONV.

Methodology: Ten articles, including eight randomized controlled trials (RCTs) and two systematic reviews, were deemed eligible for use in this systematic review. Based on the evidence from these ten articles, aprepitant was found to have superior protection against PONV in comparison to ondansetron; aprepitant in combination with ondansetron was shown to have more effectiveness than ondansetron alone against PONV; and aprepitant demonstrated improved effectiveness in the prevention of postoperative vomiting and time to first vomiting episode. With this information, a pre-test, educational module, and post-test were created for anesthesia providers to evaluate baseline knowledge and knowledge growth.

Results: The statistical analysis between the pre-test and post-test demonstrated an increase in provider knowledge on PONV and use of aprepitant.

Conclusions: Aprepitant administered alone along with aprepitant administered with ondansetron is more effective than ondansetron alone in reducing PONV rates. Implementation of an educational based intervention increased providers knowledge on information pertaining to aprepitant and its use in the prevention of PONV. Continual implementation of this quality improvement project has the potential to lead to decreased PONV rates, improved patient outcomes, and increased patient satisfaction.

Keywords: Aprepitant, Antiemetic, Ondansetron, Nausea, Vomiting, Postoperative nausea and vomiting (PONV)