PURPOSE: Despite widespread use of prophylactic antiemetics for preventing postoperative nausea and vomiting (PONV), many surgical patients undergoing general anesthesia still experience nausea and vomiting in the postanesthesia care unit, on the post-surgical ward, and at home after discharge.^1,2 This study was designed to determine the incidence and time course of PONV symptoms, and the extent of interference with postoperative functioning in high risk patients undergoing elective surgical procedures.

 METHODS: A prospective, multi-center, observational trial was conducted in patients undergoing elective surgical procedures. A subset of 63 patients undergoing major plastic surgery who had been screened for PONV risk factors³ were studied in a post hoc analysis.  Female patients who had a history of PONV/motion sickness and/or were nonsmokers were eligible to participate in this study. The incidence and severity of nausea, number of episodes of vomiting, the need for rescue antiemetics, and interference with postoperative functioning due to PONV were documented at pre-determined intervals between 0 and 72 hours postoperatively using an interactive voice recording system. Complete response (CR), defined as no emesis and no use of rescue medications, and complete control (CC), defined as CR with no moderate-to-severe nausea, were evaluated.  Interference with functioning, due to nausea and/or vomiting, was assessed using a 4-point Likert scale (1=not at all, 2=a little, 3=quite a bit, 4=very much) across 5 domains (i.e., appetite, sleep, physical activities, social life, enjoyment of life).

 RESULTS: Despite the fact that prophylactic antiemetics were administered to 95% of these patients, the CR and CC rates were 51% and 46% during the 72 hour postoperative observation period. Forty-nine percent of the patients required a rescue antiemetic. Fourteen percent of patients vomited and 35% experienced moderate-to-severe nausea. Interference with patient functioning was reported as follows: appetite (56%), sleep (44%), physical activity (44%), social interactions (32%), and general ability to enjoy life (48%). 

 CONCLUSIONS: In these high-risk patients, PONV interfered with patient functioning for up to three days following major plastic surgery procedures despite the frequent use of multi-modal antiemetic therapy.

REFERENCES:

1. White PF. Prevention of postoperative nausea and vomiting: A multimodal solution to a persistent problem. N Engl J Med. 2004;350:2511-2512.
   
2. Carroll NV, Miederhoff P, Cox FM, Hirsch JD. Postoperative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg.1995;80:903-909.
   
3. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology.1999;91:693-700.