In patients undergoing total joint arthroplasty, the combination therapy involving Ondansetron, Mosapride, and multiple doses of Dexamethasone shows better antiemetic efficacy, postoperative appetite, bowel function recovery, and pain management when compared to single-dose or Ondansetron-only regimens.

Following joint replacement surgery, experiencing nausea and vomiting can hinder recovery. This randomized clinical trial aimed to determine the effectiveness of three different preventive measures against postoperative nausea and vomiting (PONV) after primary total joint replacement surgery executed under general anesthesia.

Subjects undergoing primary total hip or knee replacement were assigned randomly to one of the three groups. Group A was treated with Ondansetron, Group B was administered 10 mg Dexamethasone alongside Ondansetron and Mosapride, and Group C was given three doses of 10 mg Dexamethasone combined with Ondansetron and Mosapride.

The overall occurrence of PONV within the first 48 hours after surgery was the key endpoint ascertained. Secondary endpoints encompassed evaluating complete response rates, the requirement for additional antiemetics, opioid use, blood glucose levels, time until first bowel movement, postoperative appetite and satisfaction, duration of hospital stay, and any postoperative complications.

Subjects in Group C exhibited a lower occurrence of overall PONV (29.3%, p = 0.001) and a higher rate of complete response (70.7%, p = 0.001) compared to those in Group A (51.9%, 48.2% respectively). Group C also had a lower occurrence of severe PONV (4.3%) compared to both Group A (25.9%, p<0.001) and Group B (20.4%, p<0.001).

Additionally, patients in Group C required less rescue antiemetic medication (1.4 ± 0.5 mg Metoclopramide) and had lower postoperative opioid consumption (1.8 ± 0.3 mg Oxycodone, 6.0 ± 1.0 mg Pethidine). They also experienced faster bowel movement recovery, shorter hospital stays, and reported enhanced postoperative appetite and satisfaction scores. Although Group C illustrated a slight rise in fasting blood glucose levels, the complication rates were similar across all the groups.

Utilizing a combination of Ondansetron, Mosapride, and three doses of Dexamethasone offered superior antiemetic efficacy, improved postoperative appetite, facilitated quicker bowel function recovery, and enhanced pain alleviation when compared to single-dose or Ondansetron-only approaches.