Orally Soluble Pellicles (OSPs) Are More Effective than Intravenous (IV) Ondansetron in Prophylaxis of Postoperative Nausea and Vomiting (PONV) After Primary Total Joint Arthroplasty (TJA): A Prospective Randomized Controlled Study.

Abstract

Despite the orally soluble pellicle (OSP) of ondansetron emerging as a novel and increasingly prescribed alternative for controlling postoperative nausea and vomiting (PONV), its superiority over its intravenous (IV) counterpart in preventing PONV remains to be definitively established. Herein, we conducted a study to compare the efficacy of OSP versus IV ondansetron in the prophylaxis of PONV following primary total joint arthroplasty (TJA) under general anesthesia. A total of 150 patients undergoing TJA were randomly assigned to one of three groups: a control group, an OSP ondansetron group (16 mg administered one hour before anesthesia induction, followed by eight mg twice daily for two postoperative days), and an IV ondansetron group (eight mg administered at anesthesia induction, followed by eight mg once daily for two postoperative days). The primary outcome was the incidence and severity of PONV within the first 48 hours postoperatively. Secondary outcomes included the time to resumption of oral intake, the dosage of rescue medications (tramadol and metoclopramide), patient satisfaction scores at discharge, serum levels of inflammatory biomarkers, and the incidence of complications. Compared with the control group, both the OSP and IV groups demonstrated significantly lower frequency and severity of PONV within the first six hours postoperatively, as well as earlier resumption of oral intake, lower requirements for rescue antiemetics, and higher patient satisfaction scores. In addition, the OSP group showed a significantly lower frequency of nausea during the 12 to 18 hours postoperatively compared with the control group. Furthermore, the OSP group had significantly higher patient satisfaction scores than those in the IV group. The OSP ondansetron demonstrated comparable efficacy to IV formulations in preventing vomiting following TJA under general anesthesia. Notably, OSP ondansetron not only exhibited superior antinausea effects compared to its IV counterpart but also achieved higher patient satisfaction scores.