Pharmacological Management of Postoperative Nausea and Vomiting in Abdominal Surgery: Efficacy of Antiemetic Protocols
Antiemetic Prophylaxis in Abdominal Surgery
DOI:
https://doi.org/10.69750/dmls.02.03.0113Keywords:
Antiemetic protocols, abdominal surgery, aprepitant, palonosetron, dexamethasoneAbstract
Background: Postoperative nausea and vomiting (PONV) are frequent and distressing complications following abdominal surgery, affecting up to seventy percent of high-risk patients. Despite multiple antiemetic options, optimal prophylaxis remains undefined in many settings.
Objective: To compare the efficacy of three pharmacologic antiemetic regimens in preventing PONV in adults undergoing elective abdominal surgery.
Methods: In this prospective study at Lahore General Hospital (January–December 2024), sixty patients aged 18–65 years were randomized into three groups (n=20 each). Group A received dexamethasone (8 mg) and ondansetron (4 mg) IV at induction. Group B received dexamethasone (8 mg) and palonosetron (0.075 mg) IV at induction. Group C received aprepitant (40 mg PO) two hours preoperatively plus dexamethasone (8 mg) and ondansetron (4 mg) IV at induction. PONV incidence, severity, vomiting episodes, and rescue antiemetic use were recorded for 24 hours postoperatively. Data were analyzed using one-way ANOVA and Chi-square tests with p < 0.05.
Results: Baseline characteristics including mean age (40.6 ± 12.4 yr), BMI (25.7 ± 4.2 kg/m²), gender distribution, smoking status, and Apfel scores were comparable across groups. Group C achieved the highest rate of no PONV (55%) and lowest rescue antiemetic requirement (5%), significantly outperforming Group A (25% none; 35% rescue; p < 0.01) and Group B (45% none; 20% rescue; p < 0.05). Severe nausea occurred in 10% of Group A, none in Group B, and 5% in Group C. Mean vomiting episodes were similar across groups. No adverse events related to antiemetic therapy occurred.
Conclusion: A multimodal regimen of aprepitant, ondansetron, and dexamethasone provides superior PONV prophylaxis compared to dual-agent protocols in elective abdominal surgery patients. Palonosetron plus dexamethasone also showed substantial efficacy and could serve as an alternative.
Downloads
References
Shan X, Yang Y, Xiao X, Zhang M, Chen R, Huang Q, et al. Enhanced efficacy of aprepitant-based triple prophylaxis in preventing postoperative nausea and vomiting following metabolic bariatric surgery: a single-center, retrospective cohort study. Frontiers in Medicine. 2025;Volume 12 - 2025.doi: 10.3389/fmed.2025.1481720
von Peltz CA, Baber C, Nou SLH. Australian perspective on Fourth Consensus Guidelines for the management of postoperative nausea and vomiting. Anaesthesia and Intensive Care. 2021;49(4):253-6.doi: 10.1177/0310057X211030518
Sharma N, Bhargava M, Chaudhary V, Sharma D, Mishra A, Chaudhary PK, et al. Comparison of antiemetic efficacy of palonosetron, ondansetron and granisetron in prevention of postoperative nausea and vomiting. International Surgery Journal. 2016;2(4):549-55.doi: 10.18203/2349-2902.isj20151078
Alam M, Shakeri A, Khorsand A, Nasseri K, Nasseri S. Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial. BMC Anesthesiology. 2023;23(1):412.doi: 10.1186/s12871-023-02371-y
Holder-Murray J, Esper SA, Boisen ML, Gealey J, Meister K, Medich DS, et al. Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens. Korean J Anesthesiol. 2019;72(4):344-50.doi: 10.4097/kja.d.18.00355
Muchatuta NA, Paech MJ. Management of postoperative nausea and vomiting: focus on palonosetron. Ther Clin Risk Manag. 2009;5(1):21-34.doi,
Fero KE, Jalota L, Hornuss C, Apfel CC. Pharmacologic management of postoperative nausea and vomiting. Expert Opin Pharmacother. 2011;12(15):2283-96.doi: 10.1517/14656566.2011.598856
Teshome D, Fenta E, Hailu S. Preoperative prevention and postoperative management of nausea and vomiting in resource limited setting: A systematic review and guideline. International Journal of Surgery Open. 2020;27:10-7.doi: https://doi.org/10.1016/j.ijso.2020.10.002
Tanveer M, Qadeer T, Ali SY, Bhatti AA, Khalid R, Suleman M, et al. Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study: Anesthesia-Related Physio-Anatomical Complications in surgical procedures. DEVELOPMENTAL MEDICO-LIFE-SCIENCES. 2024;1(2):20-7.doi: 10.69750/dmls.01.02.021
Rashid M, Shahbaz MN, Akram A, Anwar A, Umar M, Ali MS, et al. Analysis of Patients Receiving Treatment for Inflammatory Breast Disease at Surgery Department of Tertiary Care Units: Treating Inflammatory Breast Disease in Tertiary Surgery Units. DEVELOPMENTAL MEDICO-LIFE-SCIENCES. 2024;1(1):2-6.doi: 10.69750/dmls.01.01.012
Meyer TA, Habib AS, Wagner D, Gan TJ. Neurokinin-1 receptor antagonists for the prevention of postoperative nausea and vomiting. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2023;43(9):922-34.doi: https://doi.org/10.1002/phar.2814
Czarnetzki C, Albrecht E, Desmeules J, Kern C, Corpataux J-B, Gander S, et al. Dexamethasone for the treatment of established postoperative nausea and vomiting: A: randomised dose finding trial. European Journal of Anaesthesiology | EJA. 2022;39(6).doi: 10.1097/EJA.0000000000001636
Rosillo-Meneses LA, Carrillo-Torres O, Gonzalez-Navarro P, Garcia-Garcia JA. Comparison of the antiemetic efficacy of propofol versus ondansetron in nasal surgery. Randomised clinical trial. Revista Médica del Hospital General de México. 2018;81(2):72-8.doi: 10.1016/j.hgmx.2016.09.009
Zhang Y, Luo X, Fan Q, Zhou S, Kang Y, Mo Z, et al. Efficacy of fosaprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery: a multicenter, randomized, double-blind study. Anesthesiology and Perioperative Science. 2024;2(4):40.doi: 10.1007/s44254-024-00075-1
Tan HS, Dewinter G, Habib AS. The next generation of antiemetics for the management of postoperative nausea and vomiting. Best Practice & Research Clinical Anaesthesiology. 2020;34(4):759-69.doi: https://doi.org/10.1016/j.bpa.2020.11.004
Liu Y, Chen X, Wang X, Zhong H, He H, Liu Y, et al. The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis. Medicine. 2023;102(29).doi: 10.1097/MD.0000000000034385
Chandrakantan A, Glass PSA. Multimodal therapies for postoperative nausea and vomiting, and pain. British Journal of Anaesthesia. 2011;107:i27-i40.doi: 10.1093/bja/aer358
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Taimoor, Salma Kausar, Nayha Arif, Muhammad Nauman Shahid, Jan Ahmed (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
