Safer Recoveries: Proven Ways to Prevent Postoperative Nausea

For many patients, the most unpleasant part of surgery isn't the incision or the recovery, it's the wave of nausea that can follow anesthesia. Postoperative nausea and vomiting (PONV) affects nearly one in three surgical patients, and in certain groups, the rate is even higher. While often dismissed as a minor side effect, PONV can slow recovery, increase complications and extend hospital stays. For anesthesia providers, preventing it isn't just about keeping patients comfortable; it's about improving outcomes across the board.

Understanding postoperative nausea

Not every patient faces the same risk of postoperative nausea and vomiting. Certain patient factors, such as being female, a nonsmoker, younger in age or having a personal or family history of motion sickness, can increase the likelihood. The type of anesthesia also plays a role, since volatile anesthetics, nitrous oxide and opioids are all associated with higher rates of PONV.

Surgical factors matter as well, with abdominal, gynecological, ENT and laparoscopic procedures carrying greater risk. To help providers quickly gauge the level of concern, tools like the Apfel score offer a simple, evidence-based way to predict a patient's chances of developing PONV and guide prevention strategies accordingly.

Postoperative strategies

The best prevention actually begins before surgery takes place. A careful risk assessment, often using tools such as the Apfel score, allows anesthesia providers to stratify patients into low, moderate or high risk for PONV. Once risk is established, providers can discuss expectations with patients so they understand both the likelihood of nausea and the steps being taken to minimize it. This conversation not only sets the stage for better outcomes but also builds patient confidence.

For those at higher risk, prevention may include the planned use of antiemetic medications like dexamethasone or 5-HT3 antagonists, which research has shown to reduce incidence rates when administered as part of a preoperative plan.

Intraoperative tactics

What happens during surgery can make a big difference.

• Anesthetic techniques: Total intravenous anesthesia with propofol is associated with lower rates of PONV compared to volatile anesthetics. Limiting or avoiding nitrous oxide also reduces risk.
• Drug strategies: For moderate and high-risk patients, combining prophylaxis using more than one antiemetic from different classes is often most effective.
• Non-pharmacological approaches: Some evidence supports the use of acupuncture or acupressure at specific points as adjunctive methods to lower the risk of nausea.

Postoperative management

Even with careful planning, some patients will still experience nausea after surgery, and postoperative management plays a key role in maintaining comfort and safety. For higher-risk individuals, continuing antiemetics during recovery can provide an added layer of protection.

Supportive measures such as maintaining hydration, avoiding sudden fluid shifts and encouraging patients to resume eating slowly with light oral intake also help minimize symptoms. And when nausea occurs despite prevention, rescue therapy with a different class of antiemetic should be administered quickly to ensure relief and avoid prolonged discomfort.

Matching prevention to patient risk

Not all patients require the same level of intervention, and a personalized approach is the most effective. Those at low risk may need little more than thoughtful anesthetic choices to keep their recovery smooth. Patients at moderate risk, on the other hand, often benefit from two-drug prophylaxis, such as a combination of dexamethasone and ondansetron.

For those identified as high risk, a comprehensive multimodal plan, one that addresses risk factors before, during and after surgery, is important. This approach prevents overtreatment while ensuring those most vulnerable receive the most thorough protection.

Best practices for teams

Effective PONV prevention isn't just about choosing the right drugs; it's about consistent processes.

• Protocols and checklists: Embedding PONV prevention into anesthesia protocols ensures nothing is missed.
• Ongoing monitoring: Collecting patient feedback on nausea and outcomes allows teams to refine approaches.
• Team collaboration: Surgeons, anesthesia providers and nurses all play a role in prevention and early recognition.
• Documentation: Clear notes on risk assessment and prevention strategies make it easier to deliver coordinated care.

Conclusion

Preventing postoperative nausea is about more than patient comfort; it directly impacts recovery time, complication rates and overall patient satisfaction. By combining risk assessment tools with evidence-based interventions, anesthesia teams can take a proactive approach that improves outcomes for every patient.

Interested in learning more about our approach to evidence-based anesthesia care? Contact our team to discuss how we can support better outcomes for your patients.