Comparative efficacy of medications in preventing postoperative nausea and vomiting following general anesthesia in adults: a systematic review and meta-analysis

Abstract

Background: A prevalent adverse effect of general anesthesia is postoperative nausea and vomiting (PONV), resulting in considerable suffering for many surgical patients. Several medicines have been used to prevent PONV. Although these medications are commonly used, it remains unclear which ones are most effective—whether used alone or in combination—due to the absence of thorough head‒to-head trials.

Methods: This research was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature review was performed utilizing databases such as PubMed and Google Scholar. Keywords such as "general anesthesia" OR "anesthesia," "postoperative nausea" OR "postoperative vomiting" OR "PONV," "drug" OR "medication" OR "prophylaxis," were used to locate pertinent studies.

Results: There was a substantial decrease in the incidence of PONV risk with interventions, particularly 1 mg intravenous haloperidol, which demonstrated superior efficacy compared with 5 mg dexamethasone and other interventions (RR=0.27, 95% CI: 0.13–0.55). The overall heterogeneity among studies assessing PONV prevention efficacy was high (I² = 74%, P = 0.00001). Adverse events associated with interventions were minimal, with little heterogeneity for severe adverse events (I² = 0%, P = 0.23) or adverse events overall (I² = 40%, P = 0.10). The risk of bias assessment indicated that most studies were of good quality, with 18 studies having a low or unclear risk of bias and one study being classified as high risk.

Conclusions: This study revealed a statistically significant difference between pharmacological medicines used for preventing PONV in adults. Specifically, 1 mg intravenous haloperidol was found to be more effective than 5 mg intravenous dexamethasone and other interventions used in other studies. However, generally, it can be concluded that all the interventions used in general anesthesia were successful in lowering PONV among adults.

Keywords: PONV, Haloperidol, General Anesthesia, Adverse Events

Citation: AlJahdali M, AlSaeed R, Alanazi A, Alghamdi R, Al-Nawab E. Comparative efficacy of medications in preventing postoperative nausea and vomiting following general anesthesia in adults: a systematic review and meta-analysis Anaesth. pain intensive care 2026;30(6):748-761. DOI: 10.35975/apic.v30i6.3271

Received: February 05, 2016; Revised: April 08, 2026; Accepted: April 08, 2026