Postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) is a major cause of morbidity and patient discomfort. Many patients fear vomiting as much as, if not more than pain.PONV may also have an economic impact. In day-case surgery, PONV may result in delayed discharge or even overnight admission. On average, 30% of surgical patients suffer PONV symptoms but after day-case gynaecological laparoscopic surgery the incidence exceeds 50%.In the last decades, a vast amount of research has been performed in this area and new antiemetic drugs and interventions have been introduced. However, no ‘gold standard’ antiemetic intervention has been found and the incidence of PONV is still significant. The mechanism of stimulation of emesis and the factors incriminated in the development of PONV are discussed. The impact of these factors on PONV and the calculation of risk scores are presented. The antiemetic drugs as well as the non-pharmacological techniques used for prophylaxis and treatment of PONV are also reviewed.