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

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.

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