Assessment of Postoperative Nausea and Vomiting: Prevention Strategies and Outcomes

Background: Postoperative nausea and vomiting (PONV) remain a significant challenge in surgical care. This study evaluated the efficacy of ondansetron and dexamethasone, alone and in combination, for PONV prophylaxis. Methods: A prospective, randomized, controlled trial enrolled 300 adult patients undergoing elective surgery under general anesthesia. Patients were randomly allocated to four groups (n=75 each): control, ondansetron (4 mg), dexamethasone (4 mg), and combination (ondansetron 4 mg + dexamethasone 4 mg). Primary outcome was PONV incidence within 24 hours post-surgery. Results: The combination group demonstrated significantly lower PONV incidence (8.0%) compared to ondansetron (14.7%), dexamethasone (17.3%), and control groups (29.3%) (P<0.001). Rescue antiemetic requirements were lowest in the combination group (4.0%) versus control (20.0%), ondansetron (8.0%), and dexamethasone (9.3%) groups (P<0.001). Patient satisfaction was highest in the combination group (median score: 5 [IQR: 4-5], P<0.001). Multivariate analysis identified female gender (OR: 2.12, P=0.001), PONV history (OR: 2.65, P<0.001), and prolonged surgery (OR: 1.24, P=0.005) as significant risk factors. Conclusion: Combination prophylaxis with ondansetron and dexamethasone significantly reduces PONV incidence and rescue antiemetic requirements while improving patient satisfaction, without increasing complications.