Postoperative nausea and vomiting (PONV)

What is PONV?

Postoperative nausea and vomiting (PONV) is a common complication following surgery under anesthesia. it is typically defined as any nausea, retching, or vomiting that occurs during the first 24 to 48 hours after surgery.¹

PONV can complicate recovery from surgery and, while it usually resolves or is treated without serious consequences, it may sometimes require unanticipated hospital admission and delay discharge from the recovery room¹. In some cases, vomiting or retching can lead to more severe complications such as wound dehiscence, esophageal rupture, aspiration, dehydration and increased intracranial pressure¹.

PONV refers to symptoms that occur in the post-anesthesia care unit or within the immediate 24/48 hours postoperatively. When similar symptoms occur after discharge from outpatient procedures, it is referred to as postdischarge nausea and vomiting (PDNV) ¹. The pathophysiology of PONV involves a variety of central and peripheral mechanisms, with the involvement of several neurotransmitter receptors being targets for PONV prevention or treatment².

Can PONV be prevented?

The currently available antiemetic drugs for the treatment and prevention of PONV include the 5-hydroxytryptamine (5-HT₃) receptor antagonists, neurokinin-1 (NK-1) receptor antagonists, corticosteroids, butyrophenones, metoclopramide, phenothiazine, prochlorperazine, antihistamines, and anticholinergics.

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 order to reduce the likelihood of patients developing PONV and PDNV after surgery strategies to reduce the baseline risk of PONV should be implemented in addition to utilize the adequate antiemetic prophylaxis¹.