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This trial evaluates the efficacy of fosaprepitant compared to ondansetron for preventing postoperative nausea and vomiting in high-risk patients.

March 12, 2026Open Access

Fosaprepitant versus Ondansetron for Preventing Postoperative Nausea and Vomiting After Video-Assisted Thoracoscopic Lung Resection: A Randomized Controlled Clinical Trial

Key Points

This trial evaluates the efficacy of fosaprepitant compared to ondansetron for preventing postoperative nausea and vomiting in high-risk patients.
Randomized controlled clinical trial design
Included 233 adults aged 18-70 with an Apfel score ≥ 2
Participants received either intravenous fosaprepitant 150 mg or ondansetron 8 mg with dexamethasone 5 mg
Primary outcome measured was the incidence of postoperative nausea and vomiting at 24 hours post-surgery
Fosaprepitant group had a 24-hour PONV incidence of 31.0%, compared to 41.0% for ondansetron
At 48 hours, fosaprepitant reduced PONV incidence to 10.3% versus 20.5% in the ondansetron group
Fosaprepitant significantly decreased vomiting rates at both 24 hours (8.6% vs 21.4%) and 48 hours (0% vs 5.1%)

Abstract

Purpose: Postoperative nausea and vomiting (PONV) is a frequent complication after video-assisted thoracoscopic lung resection, particularly in patients at moderate to high risk, and substantially hinders recovery. Fosaprepitant, a neurokinin-1 (NK-1) receptor antagonist, is approved for PONV prevention; however, its efficacy in video-assisted thoracoscopic lung resection remains uncertain. This randomized trial evaluated the efficacy of fosaprepitant versus ondansetron in preventing PONV in high-risk patients undergoing video-assisted thoracoscopic lung resection. Patients and Methods: In this prospective, double-blind, randomized controlled clinical trial, 233 adults aged 18– 70 years undergoing elective video-assisted thoracoscopic lung resection with an Apfel score ≥ 2 were randomized 1:1 to receive intravenous fosaprepitant 150 mg or ondansetron 8 mg, each combined with dexamethasone 5 mg. The primary outcome was the incidence of PONV at 24 hours postoperatively. Secondary outcomes included the incidence and severity of PONV at 6, 12, and 48 hours postoperatively, the use of rescue antiemetics, adverse events, and recovery outcomes. Results: The 24-hour incidence of PONV was 31.0% 36 in the fosaprepitant group and 41.0% 48 in the ondansetron group (OR, 0.76; 95% CI, 0.53 to 1.07; P= 0.112). Fosaprepitant significantly reduced PONV at 48 hours (10.3% 12 vs 20.5% 24; OR, 0.51; 95% CI, 0.27 to 0.96; P= 0.032), as well as vomiting at 24 hours (8.6% 10 vs 21.4% 25; OR, 0.40; 95% CI, 0.20 to 0.80; P= 0.006) and 48 hours (0% 0 vs 5.1% 6; OR, 0.07; 95% CI, 0.00 to 1.32; P= 0.040). Conclusion: Fosaprepitant was superior to ondansetron in preventing early postoperative vomiting and delayed-phase PONV, and it represents an effective antiemetic strategy for high-risk thoracic surgical patients. Trial Number and Registry Url: Registration number, NCT05881486; https://clinicaltrials.gov . Keywords: neurokinin-1 receptor antagonist, 5-HT3 receptor antagonist, antiemetic prophylaxis, dexamethasone, video-assisted thoracoscopic surgery

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