Postoperative nausea and vomiting (
PONV) and postdischarge
nausea and
vomiting (PDNV) remain common and distressing complications following surgery.
PONV and PDNV can delay discharge and recovery and increase medical costs. The high incidence of
PONV has persisted in part because of the tremendous growth in
ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Pharmacological management of
PONV should be tailored to the patients' risk level using the
PONV and PDNV scoring systems to minimize the potential for these adverse side effects in the postoperative period. A combination of prophylactic
antiemetic drugs should be administered to patients with moderate-to-high risk of developing
PONV in order to facilitate the recovery process. Optimal management of perioperative
pain using
opioid-sparing multimodal
analgesic techniques and preventing
PONV using prophylactic
antiemetics are key elements for achieving an
enhanced recovery after surgery. Strategies that include reductions of the baseline risk (e.g., adequate hydration, use of
opioid-sparing
analgesic techniques) as well as a multimodal
antiemetic regimen will improve the likelihood of preventing both
PONV and PDNV.