CLINICAL AND METABOLIC OUTCOMES OF RISK-STRATIFIED PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS WITH MORBID OBESITY
Keywords:
postoperative nausea and vomiting, morbid obesity, bariatric surgery, multimodal prophylaxis, droperidol, B-PONVAbstract
Objective: To evaluate the clinical and metabolic outcomes of risk-stratified multimodal prevention of postoperative nausea and vomiting in patients with morbid obesity undergoing laparoscopic bariatric surgery. Materials and Methods: This ambispective comparative study included 106 patients: 53 controls and 53 protocol patients. Controls received dexamethasone 8 mg and ondansetron 4 mg; the protocol group received dexamethasone 4 mg, ondansetron 4 mg, and droperidol 1.25 mg. Results: At 6-48 hours, nausea, vomiting, and rescue antiemetic use were less frequent in the protocol group. Hospital stay was shorter and QoR-15 was higher. The B-PONV score achieved an AUC of 0.81. Conclusion: Individual risk-based three-drug prophylaxis was associated with better early recovery after bariatric surgery.
References
Ao Y., Ma J., Zheng X. et al. Opioid-Sparing Anesthesia Versus Opioid-Free Anesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis. Anesth Analg. 2025;140(2):385-396. doi:10.1213/ANE.0000000000006942.
Gan T.J., Jin Z., Ayad S. et al. Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Executive Summary. Anesth Analg. 2025. doi:10.1213/ANE.0000000000007816.
Lam P., Druar N., Swaminathan S. et al. Perioperative use of low dose haloperidol safely reduces episodes of postoperative nausea/vomiting and length of stay following elective minimally invasive bariatric surgery. Surg Endosc. 2024;38(1):407-413. doi:10.1007/s00464-023-10430-1.
Naubetova S.D. Optimizing the Prevention of Postoperative Nausea and Vomiting in Patients with Morbid Obesity Undergoing Laparoscopic Bariatric Surgery: A Prospective Evaluation. American Journal of Medicine and Medical Sciences. 2025;15(11):3824-3828. doi:10.5923/j.ajmms.20251511.14.
Shan X., Yang Y., Xiao X. 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. Front Med (Lausanne). 2025;12:1481720. doi:10.3389/fmed.2025.1481720.
Song B., Li W., Wan L. et al. Effect of Opioid-Free Versus Opioid Anesthesia on the Quality of Postoperative Recovery in Patients Receiving Laparoscopic Sleeve Gastrectomy. Obes Surg. 2025;35:3120-3130. doi:10.1007/s11695-025-08008-y.
Stenberg E., dos Reis Falcão L.F., O'Kane M. et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022;46:729-751. doi:10.1007/s00268-021-06394-9.
VanderWielen B.A., Storm A.C., Schroeder D.R. et al. Incidence of post-operative nausea and vomiting after endoscopic bariatric and metabolic therapy procedures and the role of neurokinin-1 receptor antagonists: a retrospective cohort study. Surg Endosc. 2024;38(12):7227-7232. doi:10.1007/s00464-024-11327-3.
Zhu C., Zhao T., Wu Q., Da M. The Efficacy of Aprepitant in Preventing Post-bariatric Surgery Nausea and Vomiting: Evidence from Clinical Trials. Obes Surg. 2024;34(7):2617-2626. doi:10.1007/s11695-024-07338-7.
Ризаев Ж. А., Абдуллаев Д. Ш., Асадуллаев Н. С., Иногамов Ш. М. Анализ активных механизмов модуляции кровотока микроциркуляторного русла у больных с пародонтитами на фоне ишемической болезни сердца, осложненной хронической сердечной недостаточностью // Вісник проблем біології і медицини. – 2019. – С. 338–342.
Ризаев Ж. А., Агабабян И. Р., Ярашева З. Х., Мухамедова М. Г. Значение коморбидных состояний в развитии хронической сердечной недостаточности у больных пожилого и старческого возраста // Достижения науки и образования. – 2022. – С. 75–79.
Zhu J., Wu L., Chen G. et al. Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting in patients undergoing bariatric surgery: a propensity score matching analysis. Obes Surg. 2022;32:819-828. doi:10.1007/s11695-021-05859-z.
