What Is the Best Strategy for Prevention of Postoperative Nausea and Vomiting?

INTRODUCTION

Postoperative nausea and vomiting (PONV) are among the most common side effects associated with anesthesia and surgery. Currently, the overall incidence of PONV for all surgeries and patient populations is estimated to be 25% to 30%. Furthermore, PONV can lead to a delay in postanesthesia care unit (PACU) discharge, unanticipated hospital admission, or both, thereby increasing medical costs. Symptoms of PONV are also among the most unpleasant experiences associated with surgery and one of the most common reasons for poor patient satisfaction ratings in the postoperative period. In one survey, surgical patients were willing to pay up to $100 to avoid PONV. Optimal PONV prophylaxis is also an essential component of enhanced recovery after surgery (ERAS) protocols.

Anesthesia-, patient-, and surgery-related factors associated with increased risk for PONV have been identified ( Table 29.1 ). Apfel et al. developed a simplified risk score consisting of four predictors: female gender, history of motion sickness or PONV, nonsmoking status, and the use of opioids for postoperative analgesia. If none, one, two, three, or four of these risk factors were present, the incidence of PONV was 10%, 21%, 39%, 61%, and 79%, respectively.

THERAPIES