Addition of lidocaine to prophylactic ondansetron and dexamethasone in high-risk adults for postoperative nausea and vomiting: a randomized, controlled, double-blinded study.

BACKGROUND: A triple combination of dexamethasone, ondansetron, and droperidol is recommended as prophylaxis to prevent postoperative nausea and vomiting in high-risk patients. However, the administration of droperidol is controversial owing to its fatal side effects. Considering the antiemetic effect of lidocaine, the aim of this study was to determine if its incorporation could mitigate postoperative nausea and vomiting in adults at high risk. MATERIALS AND METHODS: This randomized, controlled, double-blind study was conducted from 10 June 2023 to 31 October 2023. Based on a preliminary experiment, 260 patients were enrolled in the trial, with 130 in group C (saline) and 130 in group L (lidocaine). The primary outcome was the incidence of postoperative nausea and vomiting at 24 hours postoperatively. The secondary outcomes were the Quality of Recovery-40 (QoR-40) score at 24 hours postoperatively and the time to extubation. Adverse events that occurred during the study were recorded. RESULTS: The incidence of postoperative nausea and vomiting differed between the groups, with 26.6% (33 patients) in group C and 16.4% (21 patients) in group L (P = 0.0484). The QoR-40 score was 176.45 ± 10.87 in group C and 186.59 ± 9.79 in group L (P < 0.001). No adverse events were observed during the trial. CONCLUSION: In high-risk patients, the addition of lidocaine to ondansetron and dexamethasone effectively reduced the incidence of postoperative nausea and vomiting and improved the quality of recovery.