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Postoperative Nausea & Vomiting (PONV)

Prevention and treatment of post-surgery nausea

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Postoperative Nausea & Vomiting (PONV)?

Multifactorial condition caused by anesthetic agents, opioid analgesics, surgical stimuli, vestibular activation and patient factors activating the chemoreceptor trigger zone.

Apfel simplified score identifies risk using four factors: female sex, non-smoker, history of PONV/motion sickness, postoperative opioid use.

Affects recovery, prolongs PACU stay, causes aspiration risk, dehydration, wound dehiscence and patient dissatisfaction.

Prevention and treatment approach is multimodal, combining risk reduction and drugs targeting different receptor systems.

Symptoms

Nausea with or without vomiting in the first 24 hours post-surgery
Retching, salivation and feelings of queasiness
Difficulty tolerating oral fluids or medications
Headache, dizziness or light sensitivity accompanying nausea
Pain-related worsening of symptoms
Delayed PACU discharge or unplanned hospital admission

Risk Factors

Female sex, non-smoker and history of PONV or motion sickness
Use of volatile anesthetics, nitrous oxide and postoperative opioids
Long surgery duration, especially gynecologic, ENT, breast and laparoscopic
Pediatric age (strabismus surgery, tonsillectomy) and young adults
Pre-operative anxiety, dehydration and prolonged fasting
Motion during transport or early ambulation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent vomiting unable to tolerate fluids for 24 hours after discharge
  • Signs of dehydration, electrolyte imbalance or aspiration
  • Severe headache, fever or abdominal pain suggesting other causes

Treatment Methods

01
Identify risk with Apfel score; apply 1–2 prophylactic drugs for 1–2 risk factors, 3+ for high risk
02
Combine classes: 5-HT3 antagonist (ondansetron), dexamethasone, NK-1 antagonist (aprepitant), dopamine antagonist (droperidol, metoclopramide)
03
Reduce triggers: TIVA with propofol instead of volatiles, avoid nitrous oxide, minimize opioids with regional anesthesia
04
Adequate hydration, normothermia and optimal pain control
05
Rescue therapy with drug class different from prophylaxis; avoid repeating same agent within 6 hours
06
Non-pharmacologic: P6 acupressure, ginger, aromatherapy, gradual mobilization

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.