The Effect of Ondansetron Intravenous Administration to Caloric Intake for Patients of Gynecological Surgery

The Effect of Ondansetron Intravenous Administration to Caloric Intake for Patients of Gynecological Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Ondansetron Intravenous Administration to Caloric Intake for Patients of Gynecological Surgery Eiji Horita, Mitsuo Kaneshima, Yasuhisa Kobayashi, Masaki Sano, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8437836/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Journal of Pharmaceutical Health Care and Sciences → Version 1 posted You are reading this latest preprint version Abstract Background Postoperative nausea and vomiting can be a serious issue in reducing caloric intake for patients in the early stage after surgery. In Japan, ondansetron injection is now approved by insurance as a countermeasure against postoperative nausea and vomiting, but the number of reports on its effects in caloric intake are limited in the early stage following surgery, and opinions about the effects are divided. Thus, we examined how the effects of ondansetron administration during surgery influence caloric intake starting the day after surgery. Methods We examined 65 patients who received a 4mg injection of ondansetron during gynecological surgery under epidural anesthesia, in comparison to 51 patients who did not receive any antiemetic. Our study was to compare the amount of caloric intake the day after surgery. Results The patient group who received an ondansetron injection enjoyed higher caloric intake. Three factors of the Apfel Score showed a significant increase. Conclusions Our study indicated that ondansetron administration during gynecological surgery may have a positive effect on increasing postoperative caloric intake one day after surgery. Postoperative nausea and vomiting ondansetron caloric intake Figures Figure 1 Figure 2 Figure 3 Background Postoperative nausea and vomiting (PONV) is one of the causes of significantly reduced caloric intake in the early stage after surgery 1) . While PONV is a common adverse event during the postoperative recovery stage, it could greatly affect patient’s quality of life (QOL) and nutritional management. PONV is not limited to the day after surgery but occurs at certain frequencies even a few days after surgery 2,3,4) . In our facility’s recovery ward, we often observe patients with insufficient caloric intake due to PONV. Ondansetron is effective for prevention of PONV as a 5-HT3 receptor antagonist 5,6,7) . Japan started insurance coverage of ondansetron beginning August 2021. Of course, patients strongly wish to avoid pain and PONV 8) . For anesthesiologists also preventing the occurrence of PONV is a crucial issue 9) . We consider it great progress that we can administer ondansetron during surgery in terms of perioperative management. Reports on how ondansetron affects postoperative caloric intake at the early stage after surgery are, however, quite limited and opinions are inconclusive 1,10,11) . In this study, we examined how the effects of ondansetron administration during surgery influences caloric intake starting the day after surgery. Patients and Methods Research Design and Subjects This study is a retrospective study of patients who had gynecological surgery under epidural anesthesia from April 2021 to March 2022. We grouped 65 patients who received a 4mg ondansetron injection during surgery (Group O) and 51 patients who did not receive any antiemetic (Group C). Based on the clinical pathway, caloric intake with meals started one day after surgery （Fig. 1）. Data Collection We collected data retrospectively from electronic medical records. We examined patients’ background information such as age, weight, surgery type (vaginal surgery, laparoscopic surgery, open surgery), Apfel Score, amounts of fentanyl and anesthetic injections depending on the patient’s weight, and surgery hours. Apfel Score is an evaluation index of PONV and has the following four indicators: (1) women, (2) non-smokers (including non-smokers more than one year), (3) PONV and/or past history of motion sickness (excluding motion sickness on boat, airplane, or car sickness in childhood), (4) opioid usage after surgery 12,13,14) . We defined “non-smoker” as someone who had stopped smoking for more than a year. While there is no clear basis for this definition, we thought that nicotine may affect neural receptor changes 14) . Evaluation of PONV We evaluated PONV existence based on doctors’ orders in the electronic medical records. To be more specific, we determined that a patient experienced PONV if one of the instructions was given by doctors: (1) prescription of antiemetic, and/or (2) instruction for reduction or cancelation of epidural anesthesia due to suspicion of PONV. Evaluation of dietary intake We evaluated oral caloric intake on the day after surgery. We calculated the calories based on the meal that nurses recorded. Patients’ meal preparation generally complied with clinical pathway, but occasionally they were modified based on the patient’s taste or medical conditions (such as diabetic). The evaluation reflects realistic conditions in general, and no specific manipulations were added for the purpose of the research. Statistical Analysis We used G*Power to calculate sample size, assuming detection power 0.80, significance level as 0.05, effect size (Cohen’s d) as 0.46 (medium or average). As a result, total 154 samples, each group of 77 samples, were needed. As for statistical analysis, we used the Statistical Package for Social Science (SPSS) version 24.0 (SPSS Inc. Chicago, IL). We used Fisher’s exact test, Wilcoxon’s rank sum test, and covariance analysis (ANCOVA). In ANCOVA, we set Apfel Score, amount of anapain and fentanyl and operation hours as covariates which could potentially influence calorie intake. We set significance level p<0.05 in order to determine statistical significance. Results Patients’ Background There was no statistical difference between Group O and Group C in terms of age, weight, surgery methods, Apfel Score, amount of fentanyl, and operation hours. In the meantime, there was significantly less amount of anapain in Group O ( p=0.002 ) (Table 1) Effect on PONV PONV on the day of surgery occurred much less in Group O compared to Group C. Overall, we found a significant suppression effect in Group O where 4 factors were applicable in Apfel Score (Fig.2a, Table 2) while there was no statistical difference between groups on the day of surgery (Fig.2b, Table 2). Effect on Oral Caloric Intake Caloric intake increased significantly in Group O, compared to Group C, the day after surgery (Fig. 3). The patients with three applicable factors on Apfel Score showed a significant difference. Details on caloric intake will be shown in Table 3. Supplementary evaluation by Covariance Analysis Since the sample size may be insufficient in this study, we did covariance analysis (ANCOVA) in order to adjust influential elements that could affect caloric intake. As a result, Group O, compared to Group C, indicated much more caloric intake on the day after surgery (F=4.131, p=0.045 ). The average caloric intake in Group O were 1364.1± 55.9 kcal while it was 1188.3± 63.1 kcal in Group C. The difference between the two groups was 175.8 Kcal (95% confidence interval [-347.3, -4.3])（Table 4）. Also, when we evaluated the influence of covariates, Apfel Score gave negative influence significantly to caloric intake (F=7.386, p=0.008 , regression coefficient B=-196.8, 95% CI [-340.4, -53.3]). On the other hand, the amount of anapain and fentanyl and operation hours did not show any significant influence（Table 5）. Discussion The purpose of this study was to determine the influence of ondansetron administered during gynecological surgery on postoperative caloric intake. Conventionally, the preventive effect of ondansetron on PONV is widely recognized. Our quantitative study focused on the point that such known preventive effect could expand to postoperative caloric intake. In Group O, patients who received ondansetron during gynecological surgery showed significantly higher numbers of oral caloric intake on the day after surgery. It was especially true to the high-risk patients that applied three factors from Apfel Score. This result indicates that suppression of PONV facilitates meal intake after surgery, and promotes improvement of nutritional condition. It is particularly true that increased protein intake plays a vital role in maintaining immune function and helping with wound healing 15) . Nutritional intake at the earlier stage after surgery could also contribute to reducing the risk of infection and shortening hospital stays 16,17) . Administration of ondansetron could enable the patient to expedite resuming regular meals and drinking water even on the same day of surgery 10) . This too can be a positive element in promoting earlier nutritional intervention. This study could support those clinical efficacies. On one hand, there was a report on ondansetron which did not influence meal intake after surgery. The report was a comparison of breakfast and lunch intake one day after surgery 11) . We believe our qualitative study made it possible to evaluate caloric intake in more detail. Furthermore, as a result of covariance analysis, we recognized that the higher the Apfel Scores, the less the caloric intake becomes. It indicates that a patient with higher PONV risk tends to have more difficulty in caloric intake. We confirmed that ondansetron administration alleviates this tendency. The finding indicates the necessity of individualized anti-PONV strategies for a patient with higher risk. It also indicates that ondansetron administration is effective for postoperative nutritional management. On the other hand, the amount of anapain or fentanyl, and surgery hours did not show significant influence on caloric intake, and we think it is possible to think that the relation between PONV and caloric intake could be strongly influenced by the use of antiemetic and patient’s individual risk profile. This study is one of the rare research studies that qualitatively evaluated the influence of antiemetic administration during surgery on postoperative caloric intake. We believe that our study can provide a valuable new perspective in postoperative management. Research Limitations We recognize the following four limitations in this study. 1) The sample size is not sufficient. Specifically, we did not have enough samples on Apfel Score 2 to affect statistical power. 2) The sample patients were all females, but we did not look into the elements that could affect PONV such as menstrual cycle and menopause 18,19) . 3) Our study is a retrospective study, and evaluation of PONV depends solely on electronic medical records. There is a possibility that mild symptoms were underestimated in the records. 4) The influence of postoperative pain affecting caloric intake is not sufficiently considered. In our facility of gynecological surgeries, however, we have managed postoperative pain by regular administrating of non-steroidal anti-inflammatory drugs such as Loxoprofen and Acetaminophen. There are reports in our facility on other types of illnesses, but it effectively alleviated postoperative pain by combining non-opioid analgesics 20) . Despite these limitations, we believe our findings carry significant clinical value by showing qualitatively the influence of antiemetics during surgery on postoperative nutritional intake. Conclusions This study demonstrates the strong possibility that ondansetron administration during gynecological surgery could improve caloric intake on the day after surgery as well as suppression of PONV. We conclude that the higher risk patients show effectiveness, and we could expect this would be a newer measure of intervention. We would like to continue more studies incorporating patients’ subjective evaluation index for more practical and highly reproducible evidence. Abbreviations PONV: Postoperative nausea and vomiting; QOL: Quality of life; SPSS: Statistic package for social science Declarations Acknowledgements Not applicable. Ethics approval and consent to participate This study was approved by the Ethical Committee at Fukui-ken Saiseikai Hospital (Approval Number 2022-021). Because this was a retrospective study using existing clinical data, individual informed consent was not obtained. Instead, an opt-out approach was employed, and information about the study was disclosed to patients for a designated period, allowing them to decline participation. No patients opted out. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and material The datasets generated and analyzed during the current study are not publicly available due to privacy concerns and institutional policy but are available from the corresponding author on reasonable request. Competing interests The authors declare no conflicts of interest associated with this manuscript. Funding Not applicable. Authors’ contributions EH, MK, KoS and SS contributed to the study conception and design. EH, YK, MS, KM, HS, KH and TK gathered patient data from electronic medical records. EH, YT, KeS, YM and MK analyzed the data and wrote the manuscript. EH, MK, YM and SS provided interpretation and discussion of the data. All authors read and approved the final manuscript. Author details Not applicable. Author’ information 1 Department of Pharmacy, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. 2 Department of Obstetrics and Gynecology, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. 3 Department of Nutrition, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. 4 Department of Surgery, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. 5 Department of Anesthesiology, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. 6 Nutrition Support Team, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. References Murakami T, Wasaki R, Fukuchi K, Cho S, Shirozu K, Yamaura K. Effect of ondansetoron on postoperative nausea and vomiting and food intake after knee arthroplasty. The journal of Japan society for clinical anesthesia. 43(4): 290-296 (2023). Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB, Allard M, Turan A, Windle P, Odom-Forren J, Hooper VD, Radke OC, Ruiz J, Kovac A. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology., 117(3): 475-486 (2012). Pan PH, Lee SC, Haris LC. Antiemetic prophylaxis for postdischarge nausea and vomiting and impact on functional quality of living during recovery in patients with high emetic risks: a prospective, randomized, double-blind comparison of two prophylactic antiemetic regimens. Ambulatory Anesthesiology., 107(2): 429-438 (2008). Morino R, Ozaki M, Nagata O, Yokota M. Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center: first large-scale in Japan. Journal of Anesthesia., 27: 18-24 (2013). Bugedo G. Gonzalez J. Asenjo C. De la Cuadra JC. Gajardo A. Castillo L. Munoz H. Dagnino J. Ondansetron and droperidol in the prevention of postoperative nausea and vomiting. 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Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & analgesia., 118: 85-113 (2014). Apfel CC, Heidrich FM, Jukar-Rao S, Jalata L, Hornuss C, Whelan RP, Zhang K, Cakmakkaya OS. Evidence-based analysis of risk factors for postoperative nausea and vomiting. British journal of anaesthesia., 109(5): 742-753 (2012). Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan TJ, Shaw AD, Thacker JKM, Miller TE. American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesthesia & analgesia., 126: 1883-1895 (2018). Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ., 323(6): 773-776 (2001). Bisch S, Nelson G, Altman A. Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology. Nutrients., 11: 1088 (2019). Medina-Diaz-Cortés G, Brancaccio-Pérez IV, Esparza-Estrada I, Barbosa-Camacho FJ, Fuentes-Orozco C, Gonzalez-Hernandez PG, Chejfec-Ciociano JM, Ramirez-Sanchez MV, Sanchez-Lopez VA, Cortes-Flores AO, Alvarez-Villasenor AS, Chavez-Tostado M, Cervantes-Perez E, Cervantes-Guevara G, Cervantes-Cardona GA, Gonzalez-Ojeda A. Differences in postoperative pain, nausea, and vomiting after elective laparoscopic cholecystectomy in premenopausal and postmenopausal Mexican women. World Journal of Surgery. 46(2): 356-361 (2022). Simurina T, Mraovic B, Skitarelic N, Andabaka T, Sonicki Z. Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study. Journal of Clinical Anesthesia., 24(3): 185-92 (2012). Horita E, Takahashi Y, Takashima K, Saito K, Takashima Y, Munemoto Y. Effectiveness of scheduled postoperative intravenous acetaminophen for colon cancer surgery pain. Journal of Pharmaceutical Health Care and Sciences, 4(19): 1-5 (2018). Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table.pdf Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Journal of Pharmaceutical Health Care and Sciences → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8437836","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":566762479,"identity":"4f1d51bc-967a-4472-98bb-77ecc8071968","order_by":0,"name":"Eiji 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1","display":"","copyAsset":false,"role":"figure","size":91264,"visible":true,"origin":"","legend":"\u003cp\u003eProtocol of Scheduled Ondansetron 4mg Injection\u003c/p\u003e\n\u003cp\u003eOnly Group O patients received ondansetron injection 4 mg during surgery in order to avoid postoperative PONV. Both groups (Group O and Group C) continuously received epidural anesthesia one day after surgery. Patients in both groups resumed meals the day after surgery.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8437836/v1/3e88562895168e7d86beeaa9.png"},{"id":99292524,"identity":"f9b26d85-2977-40bd-8410-308b62cc0b6b","added_by":"auto","created_at":"2025-12-31 10:44:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":92384,"visible":true,"origin":"","legend":"\u003cp\u003eConditions of Postoperative PONV\u003c/p\u003e\n\u003cp\u003eThis comparative figure shows whether or not (“With” or “Without”) there were countermeasures against PONV on the day of and the day after surgery: a) indicates the day of surgery and b) indicates one day after surgery. Countermeasures against PONV include usage of antiemetic and /or reduction or cancellation of epidural anesthesia.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8437836/v1/33cf11e9923ca6980ca1bf00.png"},{"id":99320739,"identity":"0354220b-eb72-473c-a398-0eec4642c80c","added_by":"auto","created_at":"2025-12-31 16:38:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54773,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Caloric Intake on the day after surgery\u003c/p\u003e\n\u003cp\u003eThe figure shows the amount of caloric intake from meals one day after surgery: a) main meal and b) side dishes\u003c/p\u003e\n\u003cp\u003eUsed Wilcoxon rank sum test for statistical analysis\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8437836/v1/e0a64f3862b4b1c041bfd912.png"},{"id":103251028,"identity":"fcf4ea54-9f1e-4260-bbba-86314413704b","added_by":"auto","created_at":"2026-02-23 16:01:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":668737,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8437836/v1/e963afd6-ab70-45e2-addf-0d6145969231.pdf"},{"id":99292527,"identity":"28ad1692-ed37-4ee5-a20c-13a6dfda7728","added_by":"auto","created_at":"2025-12-31 10:44:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":177588,"visible":true,"origin":"","legend":"","description":"","filename":"Table.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8437836/v1/a011ea2c5b799f069cbf2426.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Ondansetron Intravenous Administration to Caloric Intake for Patients of Gynecological Surgery","fulltext":[{"header":"Background","content":"\u003cp\u003ePostoperative nausea and vomiting (PONV) is one of the causes of significantly reduced caloric intake in the early stage after surgery\u003csup\u003e1)\u003c/sup\u003e. While PONV is a common adverse event during the postoperative recovery stage, it could greatly affect patient\u0026rsquo;s quality of life (QOL) and nutritional management. PONV is not limited to the day after surgery but occurs at certain frequencies even a few days after surgery\u003csup\u003e2,3,4)\u003c/sup\u003e. In our facility\u0026rsquo;s recovery ward, we often observe patients with insufficient caloric intake due to PONV.\u003c/p\u003e \u003cp\u003eOndansetron is effective for prevention of PONV as a 5-HT3 receptor antagonist \u003csup\u003e5,6,7)\u003c/sup\u003e. Japan started insurance coverage of ondansetron beginning August 2021. Of course, patients strongly wish to avoid pain and PONV\u003csup\u003e8)\u003c/sup\u003e. For anesthesiologists also preventing the occurrence of PONV is a crucial issue\u003csup\u003e9)\u003c/sup\u003e. We consider it great progress that we can administer ondansetron during surgery in terms of perioperative management.\u003c/p\u003e \u003cp\u003eReports on how ondansetron affects postoperative caloric intake at the early stage after surgery are, however, quite limited and opinions are inconclusive\u003csup\u003e1,10,11)\u003c/sup\u003e. In this study, we examined how the effects of ondansetron administration during surgery influences caloric intake starting the day after surgery.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eResearch Design and Subjects\u003c/p\u003e\n\u003cp\u003eThis study is a retrospective study of patients who had gynecological surgery under epidural anesthesia from April 2021 to March 2022. We grouped 65 patients who received a 4mg ondansetron injection during surgery (Group O) and 51 patients who did not receive any antiemetic (Group C). Based on the clinical pathway, caloric intake with meals started one day after surgery\u0026nbsp;（Fig. 1）.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eWe collected data retrospectively from electronic medical records. We examined patients\u0026rsquo; background information such as age, weight, surgery type (vaginal surgery, laparoscopic surgery, open surgery), Apfel Score, amounts of fentanyl and anesthetic injections depending on the patient\u0026rsquo;s weight, and surgery hours. Apfel Score is an evaluation index of PONV and has the following four indicators: (1) women, (2) non-smokers (including non-smokers more than one year), (3) PONV and/or past history of motion sickness (excluding motion sickness on boat, airplane, or car sickness in childhood), (4) opioid usage after surgery\u003csup\u003e12,13,14)\u003c/sup\u003e. We defined \u0026ldquo;non-smoker\u0026rdquo; as someone who had stopped smoking for more than a year. \u0026nbsp;While there is no clear basis for this definition, we thought that nicotine may affect neural receptor changes\u003csup\u003e14)\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEvaluation of PONV\u003c/p\u003e\n\u003cp\u003eWe evaluated PONV existence based on doctors\u0026rsquo; orders in the electronic medical records. To be more specific, we determined that a patient experienced PONV if one of the instructions was given by doctors: (1) prescription of antiemetic, and/or (2) instruction for reduction or cancelation of epidural anesthesia due to suspicion of PONV.\u003c/p\u003e\n\u003cp\u003eEvaluation of dietary intake\u003c/p\u003e\n\u003cp\u003eWe evaluated oral caloric intake on the day after surgery. We calculated the calories based on the meal that nurses recorded. Patients\u0026rsquo; meal preparation generally complied with clinical pathway, but occasionally they were modified based on the patient\u0026rsquo;s taste or medical conditions (such as diabetic). The evaluation reflects realistic conditions in general, and no specific manipulations were added for the purpose of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used G*Power to calculate sample size, assuming detection power 0.80, significance level as 0.05, effect size (Cohen\u0026rsquo;s d) as 0.46 (medium or average). As a result, total 154 samples, each group of 77 samples, were needed. As for statistical analysis, we used the Statistical Package for Social Science (SPSS) version 24.0 (SPSS Inc. Chicago, IL). We used Fisher\u0026rsquo;s exact test, Wilcoxon\u0026rsquo;s rank sum test, and covariance analysis (ANCOVA). In ANCOVA, we set Apfel Score, amount of anapain and fentanyl and operation hours as covariates which could potentially influence calorie intake. We set significance level \u003cem\u003ep\u0026lt;0.05\u0026nbsp;\u003c/em\u003ein order to determine statistical significance.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePatients\u0026rsquo; Background\u003c/p\u003e\n\u003cp\u003eThere was no statistical difference between Group O and Group C in terms of age, weight, surgery methods, Apfel Score, amount of fentanyl, and operation hours. In the meantime, there was significantly less amount of anapain in Group O (\u003cem\u003ep=0.002\u003c/em\u003e) (Table 1)\u003c/p\u003e\n\u003cp\u003eEffect on PONV\u003c/p\u003e\n\u003cp\u003ePONV on the day of surgery occurred much less in Group O compared to Group C. \u0026nbsp;Overall, we found a significant suppression effect in Group O where 4 factors were applicable in Apfel Score (Fig.2a, Table 2) while there was no statistical difference between groups on the day of surgery (Fig.2b, Table 2).\u003c/p\u003e\n\u003cp\u003eEffect on Oral Caloric Intake\u003c/p\u003e\n\u003cp\u003eCaloric intake increased significantly in Group O, compared to Group C, the day after surgery (Fig. 3). The patients with three applicable factors on Apfel Score showed a significant difference. Details on caloric intake will be shown in Table 3.\u003c/p\u003e\n\u003cp\u003eSupplementary evaluation by Covariance Analysis\u003c/p\u003e\n\u003cp\u003eSince the sample size may be insufficient in this study, we did covariance analysis (ANCOVA) in order to adjust influential elements that could affect caloric intake. As a result, Group O, compared to Group C, indicated much more caloric intake on the day after surgery (F=4.131, \u003cem\u003ep=0.045\u003c/em\u003e). The average caloric intake in Group O were 1364.1\u0026plusmn; 55.9 kcal while it was 1188.3\u0026plusmn; 63.1 kcal in Group C. The difference between the two groups was 175.8 Kcal (95% confidence interval [-347.3, -4.3])（Table 4）.\u0026nbsp;\u0026nbsp;Also, when we evaluated the influence of covariates, Apfel Score gave negative influence significantly to caloric intake (F=7.386, \u003cem\u003ep=0.008\u003c/em\u003e, regression coefficient B=-196.8, 95% CI [-340.4, -53.3]). On the other hand, the amount of anapain and fentanyl and operation hours did not show any significant influence（Table 5）. \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to determine the influence of ondansetron administered during gynecological surgery on postoperative caloric intake. Conventionally, the preventive effect of ondansetron on PONV is widely recognized. Our quantitative study focused on the point that such known preventive effect could expand to postoperative caloric intake.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Group O, patients who received ondansetron during gynecological surgery showed significantly higher numbers of oral caloric intake on the day after surgery. It was especially true to the high-risk patients that applied three factors from Apfel Score. This result indicates that suppression of PONV facilitates meal intake after surgery, and promotes improvement of nutritional condition. It is particularly true that increased protein intake plays a vital role in maintaining immune function and helping with wound healing\u003csup\u003e15)\u003c/sup\u003e. \u0026nbsp;Nutritional intake at the earlier stage after surgery could also contribute to reducing the risk of infection and shortening hospital stays\u003csup\u003e16,17)\u003c/sup\u003e. Administration of ondansetron could enable the patient to expedite resuming regular meals and drinking water even on the same day of surgery\u0026nbsp;\u003csup\u003e10)\u003c/sup\u003e. This too can be a positive element in promoting earlier nutritional intervention. \u0026nbsp;This study could support those clinical efficacies. On one hand, there was a report on ondansetron which did not influence meal intake after surgery. The report was a comparison of breakfast and lunch intake one day after surgery\u003csup\u003e11)\u003c/sup\u003e. We believe our qualitative study made it possible to evaluate caloric intake in more detail.\u003c/p\u003e\n\u003cp\u003eFurthermore, as a result of covariance analysis, we recognized that the higher the Apfel Scores, the less the caloric intake becomes. It indicates that a patient with higher PONV risk tends to have more difficulty in caloric intake. We confirmed that ondansetron administration alleviates this tendency. \u0026nbsp;The finding indicates the necessity of individualized anti-PONV strategies for a patient with higher risk. It also indicates that ondansetron administration is effective for postoperative nutritional management. On the other hand, the amount of anapain or fentanyl, and surgery hours did not show significant influence on caloric intake, and we think it is possible to think that the relation between PONV and caloric intake could be strongly influenced by the use of antiemetic and patient\u0026rsquo;s individual risk profile.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study is one of the rare research studies that qualitatively evaluated the influence of antiemetic administration during surgery on postoperative caloric intake. \u0026nbsp;We believe that our study can provide a valuable new perspective in postoperative management. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe recognize the following four limitations in this study. 1) The sample size is not sufficient. Specifically, we did not have enough samples on Apfel Score 2 to affect statistical power. 2) The sample patients were all females, but we did not look into the elements that could affect PONV such as menstrual cycle and menopause\u003csup\u003e18,19)\u003c/sup\u003e. 3) Our study is a retrospective study, and evaluation of PONV depends solely on electronic medical records. There is a possibility that mild symptoms were underestimated in the records. 4) The influence of postoperative pain affecting caloric intake is not sufficiently considered. \u0026nbsp;In our facility of gynecological surgeries, however, we have managed postoperative pain by regular administrating of non-steroidal anti-inflammatory drugs such as Loxoprofen and Acetaminophen. There are reports in our facility on other types of illnesses, but it effectively alleviated postoperative pain by combining non-opioid analgesics\u003csup\u003e20)\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite these limitations, we believe our findings carry significant clinical value by showing qualitatively the influence of antiemetics during surgery on postoperative nutritional intake.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates the strong possibility that ondansetron administration during gynecological surgery could improve caloric intake on the day after surgery as well as suppression of PONV. We conclude that the higher risk patients show effectiveness, and we could expect this would be a newer measure of intervention. We would like to continue more studies incorporating patients\u0026rsquo; subjective evaluation index for more practical and highly reproducible evidence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePONV: Postoperative nausea and vomiting; QOL: Quality of life;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS: Statistic package for social science\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee at Fukui-ken Saiseikai Hospital (Approval Number 2022-021). Because this was a retrospective study using existing clinical data, individual informed consent was not obtained. Instead, an opt-out approach was employed, and information about the study was disclosed to patients for a designated period, allowing them to decline participation. No patients opted out. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to privacy concerns and institutional policy but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest associated with this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEH, MK, KoS and SS contributed to the study conception and design. EH, YK, MS, KM, HS, KH and TK gathered patient data from electronic medical records. EH, YT, KeS, YM and MK analyzed the data and wrote the manuscript. EH, MK, YM and SS provided interpretation and discussion of the data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Pharmacy, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. \u003csup\u003e2\u003c/sup\u003eDepartment of Obstetrics and Gynecology, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. \u003csup\u003e3\u003c/sup\u003eDepartment of Nutrition, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. \u003csup\u003e4\u003c/sup\u003eDepartment of Surgery, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. \u003csup\u003e5\u003c/sup\u003eDepartment of Anesthesiology, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. \u003csup\u003e6\u003c/sup\u003eNutrition Support Team, Fukui-ken Saiseikai Hospital; 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMurakami T, Wasaki R, Fukuchi K, Cho S, Shirozu K, Yamaura K. 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Nutrients., 11: 1088 (2019).\u003c/li\u003e\n \u003cli\u003eMedina-Diaz-Cort\u0026eacute;s G, Brancaccio-P\u0026eacute;rez IV, Esparza-Estrada I, Barbosa-Camacho FJ, Fuentes-Orozco C, Gonzalez-Hernandez PG, Chejfec-Ciociano JM, Ramirez-Sanchez MV, Sanchez-Lopez VA, Cortes-Flores AO, Alvarez-Villasenor AS, Chavez-Tostado M, Cervantes-Perez E, Cervantes-Guevara G, Cervantes-Cardona GA, Gonzalez-Ojeda A. Differences in postoperative pain, nausea, and vomiting after elective laparoscopic cholecystectomy in premenopausal and postmenopausal Mexican women. World Journal of Surgery. 46(2): 356-361 (2022).\u003c/li\u003e\n \u003cli\u003eSimurina T, Mraovic B, Skitarelic N, Andabaka T, Sonicki Z. Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study. Journal of Clinical Anesthesia., 24(3): 185-92 (2012).\u003c/li\u003e\n \u003cli\u003eHorita E, Takahashi Y, Takashima K, Saito K, Takashima Y, Munemoto Y. Effectiveness of scheduled postoperative intravenous acetaminophen for colon cancer surgery pain. Journal of Pharmaceutical Health Care and Sciences, 4(19): 1-5 (2018).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Postoperative nausea and vomiting, ondansetron, caloric intake","lastPublishedDoi":"10.21203/rs.3.rs-8437836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8437836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative nausea and vomiting can be a serious issue in reducing caloric intake for patients in the early stage after surgery. In Japan, ondansetron injection is now approved by insurance as a countermeasure against postoperative nausea and vomiting, but the number of reports on its effects in caloric intake are limited in the early stage following surgery, and opinions about the effects are divided. Thus, we examined how the effects of ondansetron administration during surgery influence caloric intake starting the day after surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe examined 65 patients who received a 4mg injection of ondansetron during gynecological surgery under epidural anesthesia, in comparison to 51 patients who did not receive any antiemetic. Our study was to compare the amount of caloric intake the day after surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe patient group who received an ondansetron injection enjoyed higher caloric intake. Three factors of the Apfel Score showed a significant increase.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur study indicated that ondansetron administration during gynecological surgery may have a positive effect on increasing postoperative caloric intake one day after surgery.\u003c/p\u003e","manuscriptTitle":"The Effect of Ondansetron Intravenous Administration to Caloric Intake for Patients of Gynecological Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-31 10:44:19","doi":"10.21203/rs.3.rs-8437836/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8302389b-9492-44b9-9e40-e43b16458e4c","owner":[],"postedDate":"December 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:00:27+00:00","versionOfRecord":{"articleIdentity":"rs-8437836","link":"https://doi.org/10.1186/s40780-026-00557-3","journal":{"identity":"journal-of-pharmaceutical-health-care-and-sciences","isVorOnly":false,"title":"Journal of Pharmaceutical Health Care and Sciences"},"publishedOn":"2026-02-20 15:57:17","publishedOnDateReadable":"February 20th, 2026"},"versionCreatedAt":"2025-12-31 10:44:19","video":"","vorDoi":"10.1186/s40780-026-00557-3","vorDoiUrl":"https://doi.org/10.1186/s40780-026-00557-3","workflowStages":[]},"version":"v1","identity":"rs-8437836","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8437836","identity":"rs-8437836","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}