Prevention of Postoperative Nausea and Vomiting

Sheila M. Wilhelm, PharmD; Michelle L. Dehoorne-Smith, PharmD; Pramodini B. Kale-Pradhan, PharmD


The Annals of Pharmacotherapy. 2007;41(1):68-78. 

In This Article

Abstract and Introduction

Objective: To review the literature on the prevention of postoperative nausea and vomiting (PONV) in adults.
Data Sources: Literature retrieval was accessed through MEDLINE (1966-December 2006) using the terms postoperative nausea and vomiting, prevention and treatment. Article references were hand-searched for additional relevant articles and abstracts.
Study Selection and Data Extraction: All studies published in English were evaluated. Those dealing with prevention and treatment of PONV in adults were included in the review.
Data Synthesis: Evidence suggests that providing prophylactic antiemetic medications in high-risk surgical patients is warranted. 5-HT3 receptor antagonists are widely used, with no one agent being clearly superior. However, studies have shown other types of agents to be more cost-effective.
Conclusions: The first step in the prevention of PONV is assessment and reduction of risk factors. Although nonpharmacologic therapies may play a role in the treatment of PONV, the mainstay of therapy for PONV is pharmacologic modalities. Patients at moderate to high risk for PONV need prophylactic antiemetic therapy. High-risk patients may require combination therapy with 2 or 3 agents from different antiemetic classes. Rescue antiemetic therapy is needed by patients who actually develop PONV. The agents of choice in such cases should be from antiemetic classes different from those used for prophylaxis of PONV.

Nausea and vomiting are caused by complex interactions of the gastrointestinal (GI) system, the vestibular system, and various parts of the brain. Postoperative nausea and vomiting (PONV) occurs in 30% of surgical patients overall and in up to 70% of high-risk patients.[1,2] Recognizing and understanding risk factors of PONV guide the decision regarding early prophylaxis versus later treatment of PONV. This review focuses on the prevention of PONV in adults.


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