Understanding and Managing Postoperative Nausea and Vomiting (PONV)

Postoperative nausea and vomiting (PONV) is a common complication following surgery, affecting up to 40% of patients. The patient most susceptible to experiencing nausea and vomiting is typically a young, non-smoking, overweight woman undergoing gynaecological surgery. Individuals with a history of PONV and those prone to motion sickness (experiencing discomfort in a car, aeroplane, or at sea) are also at increased risk.

While all anaesthetic agents have been implicated in PONV, opioids or narcotics are most frequently identified as the primary contributors. It’s important to note that the anaesthetic is often blamed for nausea and vomiting, even when these symptoms persist for days after the operation, long after traces of the anaesthetic have cleared from the body.

Several other factors can contribute to the development of PONV, including:

• Preoperative Conditions: Existing conditions such as vomiting, increased pressure within the brain, or intoxication with alcohol or other drugs.
• Surgical Procedures: Operations involving the eyes, the inner ear, the testicles, or tonsils.
• Postoperative Conditions: The presence of blood in the stomach (a condition that anti-emetic medications cannot effectively address) or a blockage in the bowel.
• Psychological Factors: Pain and anxiety.
• Environmental Factors: The presence of other patients experiencing vomiting, or the smell of food.
• Physical Factors: Rapid movement, such as being transported on a stretcher, or even a slight elevation of the head from the pillow.
• Medications: Painkillers administered during the anaesthetic or in the postoperative period.

Many of these contributing factors can be avoided or treated to minimize the likelihood of PONV. Your anaesthetist makes every effort to ensure you do not experience this complication. However, complete prevention of PONV is not always possible.

Frequently Asked Questions (FAQs)

Q: Who is most likely to experience PONV? A: Young, non-smoking, overweight women undergoing gynaecological surgery are most susceptible. Individuals with a history of PONV or motion sickness are also at increased risk.

Q: Why is the anaesthetic often blamed for PONV, even when symptoms persist for days? A: While the anaesthetic is a common contributor, other factors can cause nausea and vomiting that may not be directly related to the anaesthetic itself.

Q: What can be done to prevent PONV? A: Your anaesthetist will take steps to minimize the risk, such as avoiding certain medications and addressing underlying conditions.

Q: Are there any treatments for PONV? A: Yes, anti-emetic medications can be administered to alleviate nausea and vomiting.

Glossary of Terms

• Anti-emetic: A medication used to prevent or relieve nausea and vomiting.
• Nausea: A feeling of sickness with an inclination to vomit.
• PONV: Postoperative nausea and vomiting.
• Opioids/Narcotics: A class of pain-relieving medications.