Ginger as a low-cost option for postoperative nausea and vomiting prevention after laparoscopic surgery in low- and middle-income countries: a systematic review and meta-analysis protocol

Background: Postoperative nausea and vomiting (PONV) is a common complication following laparoscopic surgery and remains a significant source of patient discomfort and healthcare burden. Although pharmacologic prophylaxis is widely used, PONV incidence remains considerable, particularly in low- and middle-income countries (LMICs), where resource constraints may limit access to newer antiemetics. Ginger ( Zingiber officinale ), a widely available and inexpensive herbal remedy, has demonstrated potential antiemetic effects in clinical trials. However, evidence remains inconsistent, and no focused synthesis has evaluated its role specifically in laparoscopic procedures in LMICs. This protocol outlines a systematic review and meta-analysis to assess the efficacy and safety of ginger versus placebo for preventing PONV after laparoscopic surgery in LMICs. Methods: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov will be searched through February 2026 to identify randomized controlled trials comparing ginger with placebo in adults undergoing laparoscopic procedures in LMICs. Gray literature, including Google Scholar and citation tracking, will also be searched. Study selection, data extraction, and risk-of-bias assessment will be conducted independently by two reviewers using the Cochrane Risk of Bias 2 tool. Primary outcomes will include PONV incidence. Secondary outcomes will include nausea and vomiting severity, rescue antiemetic use, and adverse events. Random-effects meta-analysis will be performed using risk ratios or mean differences with 95% confidence intervals. Pre-specified subgroup and sensitivity analyses will be conducted, and evidence certainty will be assessed using GRADE. Results: This review aims to provide a focused synthesis of randomized evidence evaluating ginger for PONV prevention after laparoscopic surgery in LMICs. The findings are expected to clarify its comparative efficacy and safety profile relative to placebo. Conclusion: The findings of this systematic review and meta-analysis are expected to inform perioperative care strategies in resource-limited settings and clarify the potential role of ginger as a low-cost option for PONV prevention.