Triple prophylaxis with fosaprepitant versus dual therapy for postoperative nausea and vomiting in high-risk gynecologic surgery

Although current guidelines for postoperative nausea and vomiting (PONV) recommend multimodal prophylaxis for patients with multiple risk factors, evidence regarding the optimal triple-agent regimen for high-risk patients undergoing laparoscopic gynecologic surgery under total intravenous anesthesia (TIVA) remains limited. This single-center, double-blind, randomized controlled trial investigated the efficacy of triple prophylaxis with dexamethasone, palonosetron, and fosaprepitant compared to common dual prophylaxis with dexamethasone and palonosetron. Female patients aged 19–50 years, classified as American Society of Anesthesiologists physical status I or II, and scheduled for elective laparoscopic gynecologic surgery under TIVA between August 2023 and July 2025 were randomized to receive either dual or triple therapy. The primary outcome was the incidence of PONV within 24 h postoperatively. A total of 140 patients were analyzed. The results demonstrated that triple prophylaxis significantly reduced the incidence of PONV during the first 24 h postoperatively compared with dual therapy (27.1% vs. 47.9%; odds ratio: 0.38; 95% confidence interval: 0.19 to 0.78; p = 0.008). In conclusion, triple prophylaxis incorporating intravenous dexamethasone, palonosetron, and fosaprepitant is more effective than dual therapy for preventing PONV in high-risk patients undergoing laparoscopic gynecologic surgery under TIVA.