Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy

Because no completely effective antiemetic exists for the prevention of pos toperative nausea and vomiting (PONV), we hypothesize that a multimodal app roach to management of PONV may reduce both vomiting and the need for rescu e antiemetics in high-risk patients. After IRB approval, women undergoing o utpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. P atients undergoing the same surgical procedure who received a standard bala nced outpatient anesthetic with ondansetron 4 mg (Group II, n = 42) or plac ebo (Croup III, n = 37) prophylaxis were chosen to establish baseline incid ence of nausea and vomiting. None of the Group I patients vomited before di scharge, compared with 7% in Group II (P = 0.07) and 22% in Group III (P = 0.0003). However, one patient (2%) in Group I required treatment for sympto ms in the postanesthesia care unit, compared with 24% in Group II IP ( 0.00 01) and 41% in Group III (P < 0.0001). Time to discharge-ready was signific antly shorter in Group I(128, 118-139 min; mean, 95% confidence interval) v ersus Group II (162, 145-181 min; P = 0.0015) and Group III (192, 166-222 m in; P = 0.0001). Patient satisfaction with control of PONV was not differen t between Group I and Group II. Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management result ed in a 98% complete response rate and a 0% incidence of vomiting before di scharge; however, this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis. We conclude that both multimodal management and routine monotherapy antiemeti c prophylaxis resulted in an increased level of patient satisfaction than s ymptomatic treatment in this high-risk population.