Postoperative nausea and vomiting (
PONV) and postdischarge
nausea and
vomiting (PDNV) remain common and distressing complications following surgery. The routine use of
opioid analgesics for perioperative
pain management is a major contributing factor to both
PONV and PDNV after surgery.
PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal
activities of daily living after discharge home, and increase medical costs. The high incidence of
PONV and PDNV has persisted despite the introduction of many new
antiemetic drugs (and more aggressive use of
antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive
ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major
surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of
PONV should be tailored to the patient's risk level using the validated
PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the
perioperative period. A combination of prophylactic
antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing
PONV. In addition to utilizing prophylactic
antiemetic drugs, the management of perioperative
pain using
opioid-sparing multimodal
analgesic techniques is critically important for achieving an
enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of
PONV (e.g. adequate hydration and the use of nonpharmacologic
antiemetic and
opioid-sparing
analgesic techniques) and implementing multimodal
antiemetic and
analgesic regimens will reduce the likelihood of patients developing
PONV and PDNV after surgery.