ABSTRACT

Postoperative nausea and vomiting (PONV) is one of the complications that often occur after surgery using general anesthesia. The attempt to prevent PONV can use a multimodal approach, which involves the use of two or more antiemetic agents with different mechanisms of action. This approach is recommended as a more effective strategy compared to monotherapy, especially for patients at high risk of PONV. This study aims to identify, evaluate, and present scientific evidence on the effectiveness of multimodal antiemetics compared to monotherapy in preventing PONV, identify the most commonly used drug combinations, and analyze the factors influencing the occurrence of PONV. This study employs a systematic literature review method with a PICOTS approach on articles found through searches in the PubMed, ScienceDirect, and Google Scholar databases. Article selection was conducted based on predetermined inclusion and exclusion criteria, and their eligibility was assessed using the JBI Critical Appraisal Tool. A total of 22 articles that met the criteria were subsequently analyzed and data were synthesized. The multimodal approach provides better effectiveness in preventing PONV. The selection of antiemetic drug combinations should be tailored to the characteristics and risks of the patient.

Keywords: Combination Antiemetic Drugs, General Anesthesia, Multimodal Antiemetic, PONV

ABSTRAK

Postoperative nausea and vomiting (PONV) merupakan salah satu komplikasi yang sering terjadi setelah pembedahan menggunakan anestesi umum. Uapaya pencegahan PONV dapat menggunakan pendekatan multimodal, yaitu penggunaan dua atau lebih agen antiemetik dengan mekanisme kerja yang berbeda. Pendekatan ini direkomendasikan sebagai strategi yang lebih efektif dibandingkan dengan monoterapi, terutama untuk pasien dengan risiko tinggi PONV.Tujuan: studi ini bertujuan untuk mengidentifikasi, mengevaluasi, dan memaparkan bukti ilmiah tentang efektivitas multimodal antiemetik dibandingkan monoterapi dalam pencegahan PONV, mengidentifikasi kombinasi obat yang paling sering digunakan, dan menganalisis mengenai faktor-faktor yang memengaruhi kejadian PONV. Metode:  Penelitian ini menggunakan metode systematic literature review dengan pendekatan PICOTS terhadap artikel yang ditemukan melalui penelusuran database PubMed, ScienceDirect, dan Google Scholar. Seleksi artikel dilakukan berdasarkan kriteria inklusi dan eksklusi yang telah ditentukan, serta dinilai kelayakannya menggunakan JBI Critical Appraisal Tool. Hasil: Sebanyak 22 artikel yang memenuhi kriteria kemudian dilakukan analisis dan sintesis data. Simpulan: Pendekatan multimodal memberikan efektivitas yang lebih baik dalam pencegahan PONV. Pemilihan kombinasi obat antiemetik sebaiknya disesuaikan dengan karakteristik dan risiko pasien.

Kata Kunci: Kombinasi Antiemetik, Anestesi Umum, Multimodal Antiemetik, PONV

Al-Ghanem, S., Ahmad, M., Qudaisat, I., Samarah, W., Al-Zaben, K., Abu Halaweh, S., … Zoubi, M. (2019). Predictors Of Nausea And Vomiting Risk Factors And Its Relation To Anesthesia In A Teaching Hospital. Trends In Medicine, 19(1), 1–5. Https://Doi.Org/10.15761/Tim.1000171

Alhammadi, Y. (2023). Granisetron: An Overview Of Its Pharmacology, Clinical Efficacy, And Safety. Anaesthesia & Surgery Open Access Journal, 4(3). Https://Doi.Org/10.33552/Asoaj.2023.04.000587

Amirshahi, M., Behnamfar, N., Badakhsh, M., Rafiemanesh, H., Keikhaie, K., Sheyback, M., & Sari, M. (2020). Prevalence Of Postoperative Nausea And Vomiting: A Systematic Review And Meta-Analysis. Saudi Journal Of Anaesthesia, 14(1), 48–56. Https://Doi.Org/10.4103/Sja.Sja_401_19

Ashoor, T., Kassim, D. Y., Hasseb, A. M., & Esmat, I. M. (2020). Effects Of Aprepitant / Dexamethasone Versus Mirtazapine / Dexamethasone On Postoperative Nausea And Vomiting After Laparoscopic Sleeve Gastrectomy : A Randomized Controlled Trial Trial Registration : Research Square, 1–21. Https://Doi.Org/Https://Doi.Org/10.21203/Rs.3.Rs-107678/V1

Ashraf, R., Shah, A., Naseem, U., Awan, M. N., & Naz, F. (2024). Comparison Of Dexamethasone-Denenhydraminate And Dexamethasone-Ondansetron In Preventing Post-Operative Nausea And Vomiting After Laparoscopic Cholecystectomy. Journal Of Islamabad Medical & Dental College, 13(2), 210–216. Https://Doi.Org/10.35787/Jimdc.V13i2.1128

Bajaj, V., Singh, S., Sharma, R., Taank, P., & Dwivedi, D. (2019). Effect Of Palonosetron Monotherapy Versus Palonosetron With Dexamethasone Combination Therapy For Prevention Of Post Operative Nausea Vomiting In Children Undergoing Strabismus Surgery. International Journal Of Biomedical Research, 10(02), 1–5. Https://Doi.Org/10.7439/Ijbr.V10i2.5080

Balyan, R., Kumar, S., Lalitha, K., Aneja, S., & George, J. S. (2023). A Comparative Study Of Palonosetron With Ondansetron For Prophylaxis Of Postoperative Nausea And Vomiting (Ponv) Following Laparoscopic Gynaecological Surgeries. Romanian Journal Of Anaesthesia And Intensive Care, 29(1), 40. Https://Doi.Org/10.2478/Rjaic-2022-0005

Bukhari, S., Niazi, A. K., Ali, S. M., Arshad, M., & Taqi, M. (N.D.). Role Of Prophylactic Dimenhydrinate Versus Ondansetron As An Adjunct To Dexamethasone On Post-Operative Nausea And Vomiting In Laparoscopic Abdominal Procedures (Vol. 34).

Chandrakantan, A., & Glass, P. S. A. (2011). Multimodal Therapies For Postoperative Nausea And Vomiting, And Pain. British Journal Of Anaesthesia, 107(Suppl. 1), 27–40. Https://Doi.Org/10.1093/Bja/Aer358

Choi, E. K., Park, S. J., Park, C., & Lim, J. A. (2021). Comparison Of Palonosetron With Combined Palonosetron And Midazolam For Preventing Postoperative Nausea And Vomiting After Laparoscopic Cholecystectomy. Medicine (United States), 25(12), 1–5. Https://Doi.Org/10.1097/Md.0000000000026997

De Oliveira, G. S., Castro-Alves, L. J. S., Ahmad, S., Kendall, M. C., & Mccarthy, R. J. (2013). Dexamethasone To Prevent Postoperative Nausea And Vomiting: An Updated Meta-Analysis Of Randomized Controlled Trials. Anesthesia And Analgesia, 116(1), 58–74. Https://Doi.Org/10.1213/Ane.0b013e31826f0a0a

Ebrahimian, M., Mirhashemi, S.-H., Oshidari, B., Zamani, A., Shadidi-Asil, R., Kialashaki, M., & Ghayebi, N. (2023). Effects Of Ondansetron, Metoclopramide And Granisetron On Perioperative Nausea And Vomiting In Patients Undergone Bariatric Surgery: A Randomized Clinical Trial. Surgical Endoscopy, 37(6), 4495–4504. Https://Doi.Org/10.1007/S00464-023-09939-2

Elvir-Lazo, O., White, P. F., Yumul R, & Cruz, E. H. (2020). Management Strategies For The Treatment And Prevention Of Postoperative / Postdischarge Nausea And Vomiting : An Updated Review [ Version 1 ; Peer Review : 2 Approved ]. F1000research, 9, (Faculty Rev):983. Https://Doi.Org/Https://Doi.Org/10.12688/F1000research.21832.1

Gan, T. J., Belani, K. G., Bergese, S., Chung, F., Diemunsch, P., Habib, A. S., … Philip, B. K. (2020). Fourth Consensus Guidelines For The Management Of Postoperative Nausea And Vomiting. In Anesthesia And Analgesia (Vol. 131). Https://Doi.Org/10.1213/Ane.0000000000004833

Grigio, T. R., Sousa, A. M., Magalhães, G. G. N., Ashmawi, H. A., & Vieira, J. E. (2020). Aprepitant Plus Palonosetron For The Prevention Of Postoperative Nausea And Vomiting After Breast Cancer Surgery: A Double Blind, Randomized Trial. Clinics, 75, 1–5. Https://Doi.Org/10.6061/Clinics/2020/E1688

Hasan, A. M. E., & Abdelzaam, E.-S. (2019). A Comparative Study Between Aprepitant Only Versus Combined Ondansetron And Aprepitant As Antiemetic Therapy , Regarding Efficacy And Duration , In Journal Of Anesthesia & Clinical A Comparative Study Between Aprepitant Only Versus Combined Ondansetron An. Journal Of Anesthesia & Clinical Research, 10(5), 1000893. Https://Doi.Org/10.4172/2155-6148.1000893

Hendro, R. T., Pradian, E., & Indriasari, I. (2018). Penggunaan Skor Apfel Sebagai Prediktor Kejadian Mual Dan Muntah Pascaoperasi Di Rsup Dr. Hasan Sadikin Bandung. Jurnal Anestesi Perioperatif, 6(2), 89–97. Https://Doi.Org/10.15851/Jap.V6n2.1425

Hong, J. M., Han, Y. H., Lee, D., Hwang, B. Y., Baik, J., Cho, A. R., … Kim, E. (2021). Comparison Of Efficacy Between Palonosetron-Midazolam Combination And Palonosetron Alone For Prevention Of Postoperative Nausea And Vomiting In Patients Undergoing Breast Surgery And Patient Controlled Analgesia: A Prospective, Randomized, Double-Blind Study: A Consort-Compliant Study. Medicine (United States), 100(26), E26438. Https://Doi.Org/10.1097/Md.0000000000026438

Huang, Q., Wang, F., Liang, C., Huang, Y., Zhao, Y., Liu, C., … Zhao, Y. (2023). Fosaprepitant For Postoperative Nausea And Vomiting In Patients Undergoing Laparoscopic Gastrointestinal Surgery: A Randomised Trial. British Journal Of Anaesthesia, 131(4), 673–681. Https://Doi.Org/10.1016/J.Bja.2023.06.029

Jamtsho, P., Dorjey, Y., Dorji, N., Tshering, S., Wangmo, K. P., & Dorji, T. (2024). Factors Associated With Postoperative Nausea And Vomiting After Laparoscopic Cholecystectomy At The National Referral Hospital , Bhutan : A Cross-Sectional Study. Bmc Anesthesiology, 24(248), 1–10.

Jin, Z., Gan, T. J., & Bergese, S. D. (2020). Prevention And Treatment Of Postoperative Nausea And Vomiting (Ponv): A Review Of Current Recommendations And Emerging Therapies. Therapeutics And Clinical Risk Management, 16, 1305–1317. Https://Doi.Org/10.2147/Tcrm.S256234

Kaye, A. D. (2017). Pharmacology, An Issue Of Anesthesiology Clinics. (Alan D. Kaye, Ed.). Amerika Serikat: Elsevier Health Sciences.

Kemenkes. (2022). Hk.01.07/Menkes/1541/2022 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Anestesiologi Dan Terapi Intensif. Jdih.Kemkes.Go.Id, 1–504.

Kim, J.-H., Kim, J.-S., Jeon, Y.-G., Bae, J., Shin, K., & Hwang, B. (2023). Effect Of Dexamethasone And Ramosetron On The Prevention Of Postoperative Nausea And Vomiting In Low-Risk Patients: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Bmc Anesthesiology, 23(1), 363. Https://Doi.Org/10.1186/S12871-023-02334-3

Kishore, C. P., Rao, M. S., Kooran, S. P., Arora, R. K., & Roy, A. B. (2021). Comparative Study Of Ondansetron, Granisetron And Granisetron With Dexamethasone For Prevention Of Postoperative Nausea And Vomiting (Ponv) In Patients Undergoing Laparoscopic Cholecystectomy. Journal Of Pharmaceutical Research International, 8(2), 236–242. Https://Doi.Org/10.9734/Jpri/2021/V33i54b33759

Krenzischek, D. A. (2016). Perianesthesia Nursing Care. A. Amerika Serikat: Jones & Bartlett Learning.

Kumar, K., Kumar, R., Hussain, M., Kumari, B., & Kumar, A. (2022). Comparison Of Palonosetron Versus Palonosetron And Dexamethasone For Prevention Of Postoperative Nausea And Vomiting After Middle Ear Surgeries. Anesthesia Essays & Researches, 16(1), 17–21. Https://Doi.Org/10.4103/Aer.Aer_131_21

Kwak, H., Chang, Y. J., Lee, K. C., Jung, W. S., Kwon, S., & Jo, Y. Y. (2019). Antiemetic Efficacy Of Dexmedetomidine Versus Dexmedetomidine-Dexamethasone Combination In Patients Undergoing Breast Surgery. The Journal Of International Medical Research, 47(10), 5060–5069. Https://Doi.Org/10.1177/0300060519872031

Shivanna, Apoorva Devarahosahally, Kadni, R. R., Tausif, S. F., & Zachariah, V. K. (2022). Antiemetic Efficacy Of Prophylactic Ondansetron Versus Ondansetron With Dexamethasone Combination Therapies In Women Undergoing Breast Surgeries: A Randomized Controlled Trial. Journal Of Pharmacology And Pharmacotherapeutics, 13(2), 182–189. Https://Doi.Org/10.1177/0976500x221105758

Thanoun, A. N., Mohanad, A. Wahid, Ibraheem, S. A.-K., & Salih, I. K. (2019). The Impact Of Prophylactic Dexamethasone, Metoclopramide Or Both On Nausea And Vomiting After Laparoscopic Cholecystectomy. Al-Kindy College Medical Journal, 15(2), 69–75. Https://Doi.Org/10.1097/Sla.0b013e3181856024

Theriot, J., Wermuth, H. R. ;, & Ashurst, J. V. (2024). Antiemetics, Selective 5-Ht3 Antagonists. Retrieved From Statpearls Publishing Website: Https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk513318/%0a

Tricia A. Meyer, Larry R. Hutson, Phillip M. Morris, R. K. M. (2023). A Postoperative Nausea And Vomiting Update: Current Information On New Drugs, Old Drugs, Rescue/Treatment, Combination Therapies And Nontraditional Modalities. Advances In Anesthesia, Volume 41(Issue 1), Pages 17-38. Https://Doi.Org/Https://Doi.Org/10.1016/J.Aan.2023.05.002

Weibel, S., Schaefer, M. S., Raj, D., R, G., Pace, N. L., Schlesinger, T., & Meybohm, P. (2021). Drugs For Preventing Postoperative Nausea And Vomiting In Adults After General Anaesthesia : An Abridged Cochrane. Anesthesia, 76(7), 962–973. Https://Doi.Org/Https://Doi.Org/10.1111/Anae.15295

Wilson, O. L., Knaggs, R., Johnston, A., & Qureshi, S. (2023). Penatalaksanaan Mual Dan Muntah Pasca Operasi Pada Orang Dewasa. 1–13.