PHARMACOLOGICAL STRATEGIES FOR PROPHYLAXIS OF POSTOPERATIVE NAUSEA AND VOMITING

Abstract

Postoperative nausea and vomiting (PONV) remain among the most frequent and distressing adverse events after surgical procedures, potentially delaying discharge, increasing rescue antiemetic use, and impairing patient satisfaction. This article aimed to analyze the main pharmacological strategies used for PONV prophylaxis in surgical patients, emphasizing the efficacy of single-agent and combination antiemetic regimens. A qualitative systematic review of the last five years was conducted, covering publications from 2021 to 2026 in PubMed/MEDLINE, SciELO, LILACS, Cochrane Library, and indexed journals. Search terms included postoperative nausea and vomiting, PONV, antiemetics, prophylaxis, ondansetron, dexamethasone, aprepitant, fosaprepitant, and amisulpride. After eligibility screening and adaptation of the PRISMA 2020 flow diagram, five studies were selected. The findings indicate that multimodal prophylaxis, especially with drugs from different pharmacological classes, performs better than monotherapy in moderate- or high-risk patients. Dexamethasone, 5-HT3 receptor antagonists, NK1 receptor antagonists, and selective dopaminergic antagonists such as amisulpride are relevant options when dose, timing, risk profile, and adverse events are considered. It is concluded that pharmacological prophylaxis should be individualized, risk-based, and preferably multimodal in susceptible patients.