Nausea and Vomiting after surgery: What You Need to Know

Nausea or vomiting after surgery can be uncomfortable and concerning, but it’s a common side effect of anesthesia and surgical procedures. Known as postoperative nausea and vomiting (PONV), it affects a significant number of patients and can range from mild discomfort to more severe episodes that impact recovery. Postoperative nausea and vomiting (PONV) is a significant concern for patients, with many rating it as more distressing than postoperative pain. Most patients that have developed nausea and vomiting after surgery previously will likely develop PONV again. While PONV usually resolves or is treated without long-term effects, it can sometimes lead to unplanned hospital admissions or delayed discharge from the recovery room

In this blog post, we'll cover what PONV is, why it happens, who is most at risk, and what can be done to manage or prevent it.

What Is PONV?

PONV refers to the nausea and vomiting that occurs after a surgery, usually within the first 24-48 hours. For most patients, symptoms resolve within a day, but in some cases, they can last longer and even lead to complications such as dehydration, electrolyte imbalances, or in severe cases, aspiration (inhaling vomit into the lungs).

Why Does PONV Happen?

The exact cause of PONV is multifactorial, meaning several factors contribute to it:

1. Anesthesia: General anesthesia, which induces a temporary loss of consciousness, is one of the main triggers. Certain anesthetics can stimulate the vomiting center in the brain.

2. Surgical Procedure: Some types of surgeries, like those involving the abdomen, eyes, or middle ear, have higher rates of PONV due to their proximity to areas that stimulate nausea.

3. Pain Medications: Postoperative pain is often treated with opioid medications, which can cause nausea as a side effect.

4. Dehydration: Some patients become dehydrated before or during surgery, which can worsen nausea postoperatively.

5. Stress and Anxiety: Preoperative stress can also play a role in increasing the likelihood of experiencing PONV.

   
   

Risk Factors for PONV

While anyone can experience PONV, some factors increase your risk:

• Gender: Women, particularly those of childbearing age, are more prone to PONV.

• Age: Most studies have reported a slight, progressive decrease in PONV in adults with increasing age

• Non-smokers: Surprisingly, people who don’t smoke have a higher risk.

• History of Motion Sickness or PONV: If you've experienced motion sickness or nausea after surgery in the past, you're more likely to experience it again.

• Chemotherapy: recent chemotherapy administration

• Type of Surgery: Surgeries like abdominal, gynecological, and ear, nose, and throat procedures tend to have higher rates of PONV.

How Is PONV Treated?

If you experience nausea or vomiting after surgery, your healthcare team will take steps to manage your symptoms:

1. Anti-nausea Medications (Antiemetics): These are the first line of defense. Medications like ondansetron or promethazine can help alleviate nausea. A scopalamine patch can be placed behind the ear to control nausea for 72hrs. 

2. Steroids: Such as Dexamethasone 4-8mg IV is also useful before surgery 

3. Hydration: Intravenous fluids are often given to prevent dehydration, which can worsen nausea.

4. Dietary Adjustments: You may be advised to start with clear liquids and gradually transition to solid foods as your symptoms improve.

5. Non-drug Approaches: Ginger, acupressure, and aromatherapy (like inhaling peppermint, alcohol wipes, or lavender) have been explored as natural remedies for nausea.

   
   

Can PONV Be Prevented?

Your surgical team will assess your risk for PONV before surgery. If you are considered high risk, steps can be taken to reduce the likelihood of experiencing it:

1. Preoperative Medications: Anti-nausea medications can be given before surgery to help prevent PONV.

2. Anesthesia Adjustments: Your anesthesiologist may use different techniques or medications to minimize your risk.

3. Minimizing Opioid Use: Non-opioid pain management strategies may be recommended to reduce the nausea-inducing effects of opioids.

   
   

When to Call Your Doctor

While PONV typically resolves on its own, there are situations where you should seek medical help:

• Severe vomiting that doesn't improve with medication.

• Inability to keep down fluids or food for more than 12 hours.

• Signs of dehydration, such as dry mouth, dizziness, or dark urine.

• Severe abdominal pain or bloating.

Final Thoughts

Postoperative nausea and vomiting can be an uncomfortable but manageable part of recovery after surgery. Knowing the causes and risks can help you work with your healthcare team to prevent and treat PONV effectively. If you have any concerns, be sure to discuss them with your doctor prior to your procedure.

By understanding and preparing for PONV, you can make your recovery as smooth as possible. Please, don't hesitate to call us if you develop any worrisome symptoms.

References: American Society of Anesthesiologists. "Postoperative Nausea and Vomiting."