Evidence-Based Update and Controversies in the Treatment and Prevention of Postoperative Nausea and Vomiting

Abstract

P ostoperative nausea and vomiting (PONV) are frequent and unpleasant side effects of surgery. The overall incidence of PONV has decreased from 60% when ether and cyclopropane were used, to approximately 30% nowadays, [1,2] although in certain high-risk patients the incidence is still as high as 70% [3,4]. PONV can increase medical costs from delayed recovery room discharge or unplanned admissions after outpatient surgery [5]. One study estimated that the cost of PONV to a busy ambulatory surgical unit ranged from $0.25 million to $1.5 million in lost surgical revenue [6]. For patients, nausea and vomiting are among the most unpleasant experiences associated with surgery and one of the most common reasons for poor patient satisfaction rating in the postoperative period [7]. Philip reported that patients ranked the absence of PONV as more important than earlier discharge from an ambulatory surgical unit [8]. Macario and colleagues [9] quantified patients’ preferences for postoperative outcomes. PONV were among the 10 most undesirable outcomes following surgery, with vomiting being the most undesirable outcome. Patients allocated the highest amount (about $30) to avoid PONV out of a total of $100 they were allowed to spend to avoid all complications. Gan and colleagues [10] also reported that surgical patients were willing to pay up to $100, at their own expense, to avoid PONV. PONV may be associated with serious complications such as wound dehiscence, pulmonary aspiration of gastric contents, hematoma formation beneath skin flaps, dehydration, electrolyte disturbances, Mallory-Weiss tear, and esophageal rupture [11–13]. Intraocular hemorrhage resulting in loss of vision, [14] and subcutaneous emphysema causing airway compromise as a result of prolonged postoperative vomiting (POV) have also been reported [15,16]. This article discusses identification of patients at risk for PONV, highlights current options for the prophylaxis and treatment of PONV (with emphasis