Post-Operative Nausea & Vomiting (PONV)

Post-operative nausea and vomiting (PONV) is unfortunately a very common side effect of surgery and anesthesia, affecting roughly 1/3 of patients in the general surgical population. PONV can lead to longer stays in the recovery room, increased healthcare costs, and more importantly it is extremely uncomfortable for the patient. You may be at increased risk for experiencing PONV if you are younger (age < 50), have a history of motion sickness, or have had nausea after anesthesia in the past. In addition, women and non-smokers have an increased risk of PONV (though we certainly do not advocate picking up smoking before your procedure!) The procedure itself can also affect your risk. Longer surgeries, surgeries that require general anesthesia, and more painful procedures that require postoperative opioid medications, can be more likely to cause nausea.

To try to prevent nausea and vomiting, we routinely give anti-nausea medications during the procedure prophylactically. These include ondansetron and dexamethasone when not contraindicated. For higher risk patients and surgeries, we will often place a scopolamine patch behind the ear. This is ideally done the night before surgery, or at least 2 hours before the procedure. Opioids are known to cause complications such as nausea and vomiting. However, using regional anesthesia (non-opioid numbing medication) to control pain can greatly reduce the chance of these complications. For patients with a history of severe PONV, we can utilize something called total intravenous anesthesia (TIVA) and avoid the inhaled gas anesthetic medications entirely. These medications (sevoflurane and desflurane), along with opioids, are the main cause of nausea after surgery.

If you have experienced nausea and vomiting after procedures in the past, it is important to let your anesthesiologist know so that we can take steps to ensure you have a more pleasant experience. We know that feeling nauseous can be very distressing, so we make a concerted effort to avoid this very serious complication. All of the anesthesiologists at Trinity Anesthesia are fellowship-trained in Regional Anesthesiology and Acute Pain Medicine, allowing us to provide state-of-the-art opioid-sparing anesthesia. When under our care, you can feel confident that the latest anesthetic techniques will be employed to help decrease your chance of nausea and vomiting as much as possible.