Post-Operative Nausea and Vomiting- Etiology, Treatment and Prevention

Post-Operative Nausea and Vomiting- Etiology, Treatment and Prevention

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By Dr. G.P. Dureja , Pain Management

Post-Operative Nausea and Vomiting (PONV) is a common complication of surgery and anaesthesia. Although it is not considered fatal, PONV is unpleasant and associated with patient discomfort, and dissatisfaction. It leads to delays in post-operative recovery and discharge from hospital.

There is a high risk of PONV to patients within the first 24 hours of surgery.

General Effects of PONV:

  1. Patients Discomfort
  2. Delay in discharge from hospital
  3. Re-admission in case of severe concerns

Etiology-

There are 3 factors that predominantly contribute to the higher chance of PONV in a patient:

  1. Surgical Related:
    1. Laparoscopic (especially gynecological)
    2. Strabismus
    3. Middle ear
    4. Orchiopexy
    5. Stomach
    6. Duodenal
    7. Gall bladder
    8. Extracorporeal shock wave lithotripsy

The length of surgery has also been correlated with PONV risk, as a result of increased duration of anesthesia.

  1. Patient Related:
    1. Obesity
    2. Anxiety
    3. History of Motion Sickness
    4. GASTROPARESIS- Patient is Female
    5. Age between 11 & 14
  2. Post- Operative Factors:
    1. Pain (especially pelvic)
    2. Dizziness – Dehydration
    3. Hypotension
    4. Motion – Sitting up too early
    5. Early Oral Intake
    6. Post-Operative Narcotics

Treatment:

Recovery staff may administer the appropriate antiemetics prescribed on the PONV label (both the white and orange areas).

If there are no appropriate antiemetics to administer, advice must be sought from an anaesthetist.Since most antiemetics have undesirable side effects, or are expensive, alternative treatments for PONV are found to be available:

Acupuncture: The P6 (Neiguan) acupuncture point is located 2 “Chinese inches” (the width of the proximal interphalyngeal thumb joint) proximal to the distal wrist crease, approximately 1 cm deep to the skin, between the tendons of the flexor carpi radialis and the palmaris longus. Stimulation of this point is reported to reduce nausea, and anti-sea sickness elastic wrist bands with a sphere to apply pressure to this point are sold commercially.

Ginger Root: Herbal medicine has been practiced for thousands of years with mixed results. Ginger root has been found effective in PONV.Prevention:

  1. Patients should inform about previous operations and anaesthetics, and their experiences of PONV.
  2. Patients should be encouraged to report PONV and expect to receive prompt effective treatment.
  3. All pre-operative patients should get assessed for their PONV risk, taking into account the risk factors and the type of surgery and anaesthetic which they will receive.
  4. Pre operative fasting guidelines to be followed under consultation.
  5. The patient to be well hydrated pre and intra-operatively.

Post evaluating the risk of PONV, medications are given by the anaesthetist for better control.