Enhancing ERAS With Fosaprepitant or Fosaprepitant + Paragastric Autonomic Nerve Blockade

Background: Patients undergoing Bariatric and Foregut procedures are at increased risk of complications from postoperative nausea and vomiting (PONV) and pain. In this study, we investigated enhancement of standard Enhanced Recovery After Surgery (ERAS) protocol with fosaprepitant and paragastric autonomic nerve blockade (PGANB) with bupivacaine liposome injectable suspension (BLIS). Methods: We analyzed 91 patients undergoing Bariatric surgery and/or Hiatal Hernia Repair (HHR) who received standard ERAS protocol alone (Group S), with fosaprepitant (Group F), or with fosaprepitant and PGANB (Group FP). We collected patient demographics, PONV Intensity Scale ratings, pain scores, and PRN pain medications at 6 and 24 hour time points. Results: Kruskal-Wallis testing revealed differences in PONV across intervention groups ( P = .033). Post-hoc analysis with Conover-Iman (pCI), Cliff’s delta (Δ), and Cohen’s D (d) showed decreased PONV in Group F compared to Group S (pCI = 0.028, Δ = 0.280, d = 0.508). LOS for any Bariatric surgery decreased ( P = .046) by approximately 19.9 hours in group F versus group S (pCI = 0.062, Δ = 0.424, d = 0.657) and by approximately 11.2 hours in group FP versus group S (pCI = 0.084, Δ = 0.389, d = 0.416). HHRs showed no significant intervention-dependent differences in LOS or PONV. Conclusions: Our results demonstrate positive associations between the addition of fosaprepitant to standard ERAS protocols in Bariatric patients and PONV control. Further investigation into the role of fosaprepitant is warranted in Foregut and Bariatric patients. Further studies should also focus on optimizing anesthetic agent selection and multimodal analgesia, including PGANB, in the context of enhanced ERAS protocols with fosaprepitant.