To explore whether oral mosapride can prevent postoperative nausea and vomiting (PONV) after total joint arthroplasty under general anesthesia.

The patients undergoing primary total hip or knee arthroplasty under general anesthesia with preoperative PONV risk factors (Apfel score ≥one) were randomly divided into the mosapride group and the control group. The patients with hepatic and renal insufficiency, severe intestinal peristalsis, atrioventricular block or ventricular arrhythmia were excluded. The mosapride group began to take mosapride (5 mg, three times per day) 3 h before the operation, while the control group took placebo. All the patients were given ondansetron as the basic preventive measure for PONV at the end of anesthesia. The primary outcomes were the incidence of PONV within 48 h after the operation. The secondary outcomes included the first defecation time, appetite score and satisfaction score one to three days after the operation, and the incidence of gastrointestinal and cardiac complications. For quantitive data, t test or U test was used for comparison, and chi square test was used for qualitative data.

A total of 198 patients were enrolled, including 98 patients in the mosapride group and 100 patients in the control group. Within 48 h after operation, the incidence of PONV in the mosapride group was lower than that in the control group [(22.4% vs 47.0%), χ²=13.140, P<0.01]. The incidence of severe PONV [(6.1% vs 27.0%), χ²=15.533, P<0.01], the ratio of moderate to severe PONV [(15.3% vs 38.0%, )χ²=13.004, P<0.01] in the mosapride group was lower than that in the control group. The median lasted time of PONV in the mosapride group was 0.1 h, which was less than that in the control group [(0.1 vs 1.0) h, Z=-2.708, P <0.01]. In the mosapride group, the first defecation time[(59.9±22.5) h vs (39.2±18.2)h, t=7.092, P<0.01], ambulation time [(23.7±5.5) h vs (21.0±5.4) h, t=3.423, P<0.01] and the length of hospital stay [(5.4±1.5) d vs (4.7±1.4)d, t=3.496, P<0.01] were shorter. The appetite score on the first day [(1.9±0.4) vs (2.2±0.5), t=-5.112, P<0.01] and the third day [(2.0±0.8) vs (2.5±0.6), t=-4.977, P<0.01] and the satisfaction score at discharge [(7.9±1.1) vs (9.1±1.1), t=-6.845, P<0.01)] were higher. There was no significant difference in the incidence of long QT syndrome and gastrointestinal complications between the two groups (P>0.05).

Oral mosapride is safe and effective in reducing the incidence and duration of nausea and vomiting after total hip and knee arthroplasty under general anesthesia; at the same time, oral mosapride can also promote the recovery of postoperative intestinal function and appetite.