PERSPECTIVE article
Front. Anesthesiol.
Sec. Perioperative Medicine
Volume 4 - 2025 | doi: 10.3389/fanes.2025.1610320
This article is part of the Research TopicEditors' Showcase: Perioperative MedicineView all 6 articles
The Ambitious Anesthetist Aiming for Zero Nausea/Vomiting: Can a €55 Gram of Prevention obviate a €5000 Kilogram of Cure? A Cost-Minimization and Cost-Benefit Perspective (Revision/Resubmission July 2025)
Provisionally accepted
- 1University of Pittsburgh, Pittsburgh, United States
- 2VA Pittsburgh Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Pittsburgh, Pennsylvania, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
We review a published a 5-drug regimen (palonosetron, perphenazine, aprepitant, diphenhydramine, and dexamethasone) for preventing postoperative nausea/vomiting (PONV), associated with <~10% PONV on Days 0-1 in cohorts that include high-risk patients (e.g., bariatric sleeve gastrectomy, and intrathecal morphine use). Combining this 5-drug regimen with 3-drug booster dosing for inpatients (palonosetron, perphenazine, and aprepitant) may benefit both patients and hospitals, with remarkable implications on cost-benefit and cost-minimization. We also report potential for sustained PONV prevention during/after surgery as a “tandem primary prevention maneuver” to avoid abuse-liable opioids throughout the hospitalization. Phrased alternatively, we are recommending pursuit of multimodal, five-drug antiemetic clinical research that not only addresses general and specific contexts of perioperative intrathecal morphine / methadone / buprenorphine use, but also proposes foundations of adverse pharmacoeconomic interactions be-tween nausea (that is not pre-emptively addressed) and opioid escalation after surgery.
Keywords: Palonosetron, Perphenazine, Aprepitant, Diphenhydramine, Dexamethasone, Postoperative Nausea and Vomiting
Received: 11 Apr 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Williams, La Colla and Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Brian A. Williams, University of Pittsburgh, Pittsburgh, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.