Add on oral Olanzapine to anti emetics may Reduce Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common complications faced by many patients after surgery, particularly those with multiple risk factors. Despite prophylactic measures, up to 40% of patients still experience these distressing symptoms. However, a recent study published in Anaesthesia Journal has discovered that Olanzapine, an antipsychotic drug used in palliative care and for chemotherapy-induced nausea and vomiting, has shown great promise as a prophylactic anti-emetic.

The study, a multiply-blinded randomized controlled trial, targeted patients aged 18–60 years with cancer, deemed at high risk for PONV due to three or four risk factors according to the Apfel criteria. Additionally, participants had a previous history of chemotherapy-induced nausea and vomiting. The trial sought to assess whether pre-operative oral olanzapine, combined with intra-operative dexamethasone, ondansetron, and total intravenous anesthesia, could effectively reduce the incidence of PONV.

A total of 100 patients were enrolled, with 47 in the olanzapine group and 49 in the control group. Both groups received the standard two-drug regimen of dexamethasone and ondansetron, along with propofol anesthesia to prevent PONV. However, the olanzapine group received an additional 10 mg of olanzapine or placebo orally one hour before surgery.

The results were astounding. The incidence of PONV within the first 24 hours after surgery was significantly lower in the olanzapine group, with only 26% (12 out of 47) of patients experiencing nausea or vomiting.

In contrast, the control group had a much higher incidence of 63% (31 out of 49) (p = 0.008, RR 0.40 (95%CI 0.21–0.79)). This 37% relative risk reduction represents a breakthrough in postoperative care for patients with a history of chemotherapy-induced nausea and vomiting and at least three Apfel risk factors for PONV.

The findings hold immense potential for improving patient outcomes and reducing post-surgical complications. The inclusion of olanzapine as a prophylactic anti-emetic alongside existing medications proved highly effective in mitigating PONV risk, particularly in high-risk patients. This breakthrough could lead to a significant improvement in the postoperative experience for numerous individuals undergoing cancer-related surgeries.

Source:

Grigio, T. R., Timmerman, H., Martins, J. V. B., Slullitel, A., Wolff, A. P., & Sousa, A. M. (2023). Olanzapine as an add‐on, pre‐operative anti‐emetic drug for postoperative nausea or vomiting: a randomised controlled trial. In Anaesthesia. Wiley. https://doi.org/10.1111/anae.16081