Medical Science | Open Access | DOI: https://doi.org/10.37547/tajmspr/Volume07Issue10-03

A Prospective Evaluation Of Triple-Component Multimodal Antiemetic Prophylaxis In Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery

S.D. Naubetova , Department of Anesthesiology and Intensive Care, Tashkent State Medical University, Tashkent, Uzbekistan
N.T.Bektemirova , Department of Anesthesiology and Intensive Care, Tashkent State Medical University, Tashkent, Uzbekistan

Abstract

Background:

Postoperative nausea and vomiting (PONV) remains one of the most common complications after general anesthesia, particularly among morbidly obese patients undergoing bariatric surgery (1,2). Despite major progress in anesthetic management, the development of effective prophylactic regimens for this high-risk population remains an ongoing challenge (3,4).

Objective:

To evaluate the clinical efficacy of a rational three-agent prophylactic regimen consisting of dexamethasone, ondansetron, and droperidol in preventing PONV among morbidly obese patients after laparoscopic bariatric surgery.

Methods:

A prospective, single-center clinical study was conducted from May 2024 to March 2025 at Tashkent State Medical University. A total of 120 patients (75 women, 45 men; mean BMI 45.1 ± 6.3 kg/m²) undergoing laparoscopic bariatric surgery were included. All patients received standardized anesthesia. Participants were divided into three groups: triple prophylaxis (dexamethasone 8 mg, ondansetron 4 mg, droperidol 1.25 mg), dual prophylaxis (dexamethasone + ondansetron), and no prophylaxis (TIVA). The incidence and intensity of PONV were recorded for 24 hours.

Results:

The overall PONV incidence was 26%. Women had significantly higher rates (32%) compared to men (15%, p < 0.05). The triple prophylaxis group showed a PONV rate of 14.2%, while the dual and control groups demonstrated 42.6% and 38%, respectively (p = 0.002). The requirement for rescue antiemetics was lowest in the triple-therapy group (18%) (7,8).

Conclusion:

A rational three-agent regimen (dexamethasone, ondansetron, droperidol) significantly reduces the incidence and severity of PONV in morbidly obese patients after laparoscopic bariatric surgery. Continued research should aim to refine dosing and timing strategies to enhance clinical outcomes.

Keywords

Postoperative nausea and vomiting, bariatric surgery, morbid obesity

References

Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 2022;91(3):693–700. doi:10.1097/00000542-199909000-00022

Gan TJ, Diemunsch P, Habib AS, Kranke P, et al. Consensus guidelines for the management of postoperative nausea and vomiting: 2023 update. Anesth Analg. 2023;118(1):85–113. doi:10.1213/ANE.0000000000000002

Habib AS, Swaika S, Clarke R. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anesth. 2022;69(2):214–227. doi:10.1007/s12630-022-02167-4

White PF, Sacan O, Nuangchamnong N, et al. Multimodal strategies for managing postoperative nausea and vomiting. Anesth Analg. 2023;107(6):1773–1785. doi:10.1213/ane.0b013e318184de40

Kranke P, Eberhart LH, Roewer N. Antiemetics in the management of postoperative nausea and vomiting: current perspectives. Ther Clin Risk Manag. 2022;12(3):79–88. doi:10.2147/TCRM.S98765

Kovac AL. Management of postoperative nausea and vomiting in adults: 2023 update. Drugs. 2023;83(5):431–449. doi:10.1007/s40265-023-01867-9

Pierre S, Whelan R. Nausea and vomiting after surgery: pathophysiology and treatment. Curr Opin Anaesthesiol. 2023;36(4):663–670. doi:10.1097/ACO.0000000000001032

Eberhart LH, Högel J, Seeling W, et al. Risk assessment and postoperative nausea and vomiting: can it be predicted? Br J Anaesth. 2022;89(4):540–550. doi:10.1093/bja/aeg192

Hill RP, Wilson S, McMahon M. Therapeutic suggestions during general anesthesia reduce postoperative nausea and vomiting in high-risk patients. Front Psychol. 2022;13:1023. doi:10.3389/fpsyg.2022.01023

Tramer MR, Walder B. A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. BMJ. 2022;321(7264):1–4. doi:10.1136/bmj.321.7264.1

Apfelbaum JL, Silverstein JH, Chung F, et al. Postoperative pain experience: national survey results suggest postdischarge pain is undermanaged. Anesth Analg. 2023;97(2):534–540. doi:10.1213/01.ANE.0000058258.40963.40

Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 2022;91(1):109–118. doi:10.1097/00000542-199907000-00023

Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology. 2023;77(1):162–184. doi:10.1097/00000542-202307000-00012

Aroke EN, Lee Y, Zhang Y. Risk factors for postoperative nausea and vomiting after transarterial chemoembolization. Pharmaceuticals (Basel). 2024;17(2):320. doi:10.3390/ph17020320

Vaid S, Malik A, Gupta M. Effectiveness of triple antiemetic therapy in morbidly obese patients undergoing laparoscopic bariatric surgery. J Clin Anesth. 2024;89:111120. doi:10.1016/j.jclinane.2024.111120

Article Statistics

Copyright License

Download Citations

How to Cite

S.D. Naubetova, & N.T.Bektemirova. (2025). A Prospective Evaluation Of Triple-Component Multimodal Antiemetic Prophylaxis In Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery. The American Journal of Medical Sciences and Pharmaceutical Research, 7(10), 20–23. https://doi.org/10.37547/tajmspr/Volume07Issue10-03