PONV/PDNV: Why Is It Still the "BigLittleProblem?".

Abstract

DESPITE ADVANCES IN anesthesia technique and antiemetic therapy, postoperative and post-discharge nausea and vomiting (PONV/PDNV) remain “big, little problems” 1 Kapur P.A. Editorial: The Big “Little Problem”. Anesth Analg. 1991; 73: 243-245 Crossref PubMed Google Scholar , 2 Samuels J.D. Perioperative nausea and vomiting: much ado about nothing?. Aesthetic Plast Surg. 2013; 37: 634-635 Crossref PubMed Scopus (3) Google Scholar , 3 Sussanne B. Arwestrom C. Baker A. Bertero C. Nurses' experiences in the relief of postoperative nausea and vomiting. J Clin Nurs. 2010; 19: 1865-1872 Crossref PubMed Scopus (8) Google Scholar for surgical patients and the surgical healthcare team. The incidence of PONV is around 50%, with an incidence of 80% in high-risk patients. 4 Odom-Forren J. Measurement of postdischarge nausea and vomiting for ambulatory surgery patients: a critical review and analysis. J Perianesth Nurs. 2011; 26: 372-383 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , 5 Gan T.J. Diemunsch P. Habib A.S. et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118 ([Erratum appears in Anesth Analg. 2014 Mar;118(3):689]): 85-113 Crossref PubMed Scopus (920) Google Scholar Post-discharge nausea and vomiting occurs in as many as 57% of patients on the day of surgery, and may persist for as long as 7 days postoperatively. 6 Apfel C.C. Philip B.K. Cakmakkaya O.S. et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?. Anesthesiology. 2012; 117: 475-486 Crossref PubMed Scopus (198) Google Scholar , 7 Odom-Forren J. Hooper V. Moser D.K. et al. Postdischarge Nausea and Vomiting: Management Strategies and Outcomes Over 7 Days. J Perianesth Nurs. 2013; 29: 275-284 Abstract Full Text Full Text PDF Scopus (22) Google Scholar , 8 Odom-Forren J. Jalota L. Moser D.K. et al. Incidence and predictors of postdischarge nausea and vomiting in a 7-day population. J Clin Anesth. 2013; 25: 551-559 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar The annual costs associated with the treatment of, complications associated with, or time lost from work and/or daily activities related to PONV/PDNV are estimated to be several million US dollars on an annual basis. 2 Samuels J.D. Perioperative nausea and vomiting: much ado about nothing?. Aesthetic Plast Surg. 2013; 37: 634-635 Crossref PubMed Scopus (3) Google Scholar , 5 Gan T.J. Diemunsch P. Habib A.S. et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118 ([Erratum appears in Anesth Analg. 2014 Mar;118(3):689]): 85-113 Crossref PubMed Scopus (920) Google Scholar , 6 Apfel C.C. Philip B.K. Cakmakkaya O.S. et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?. Anesthesiology. 2012; 117: 475-486 Crossref PubMed Scopus (198) Google Scholar , 7 Odom-Forren J. Hooper V. Moser D.K. et al. Postdischarge Nausea and Vomiting: Management Strategies and Outcomes Over 7 Days. J Perianesth Nurs. 2013; 29: 275-284 Abstract Full Text Full Text PDF Scopus (22) Google Scholar Despite this high incidence and the related physiological and psychological impact on the patient and family, PONV/PDNV receives little attention outside of the surgical environment and research surrounding these adverse phenomena frequently goes unfunded outside of industry funded pharmaceutical trials. Vallire D. Hooper, PhD, RN, CPAN, FAAN, is a Manager, Nursing Research, Mission Hospital, Asheville, NC