Background: postoperative nausea and vomiting (PONV) are a common distressing symptoms in patients undergoing laparoscopic surgery and can contribute to anxiety, dehydration,  metabolic abnormality,  wound disruption, delayed recovery and other issues. The incidence of PONV varies from 20 to 80 % of all surgeries, and it is an economic and social burden. Aim of the Work: was to assess whether dexamethasone is a cost-effective alternative to ondansetron in the prevention of PONV in patients undergoing laparoscopic surgery. Patients and Methods: A study was conducted at Ain Shams University Hospitals between November 2017 and April 2018, after obtaining approval of research ethical committee and patients' informed consents. 80 Patients were included in the study and underwent elective laparoscopic surgery and received general anesthesia. Results: The study showed a statistically significant difference between groups regarding PO nausea and other postoperative complications. Conclusion: Dexamethasone 8 mg was as effective as ondansetron 4 mg. Dexamethasone provided a simple, safe, cheap, and effective postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden.