Post-Operative Nausea and Vomiting

Post-Operative Nausea and Vomiting

Does PONV still haunt your practice?

I’m just curious, how many people have problems with PONV? How do you treat patients to prevent PONV?

I recently asked a student to tell me the PONV risk factors that our patient had, and they could not! In fact, they couldn’t identify risk factors at all. I was completely floored that a junior student had no strategy on how to prevent PONV!

For the most part, I use Apfel’s scoring system with corresponding treatments.

The literature has several different scoring systems with slightly varying criteria. I think using any of the systems to identify the risk level of each patient is beneficial in helping prevent PONV.

Here is the basics of Apfel’s scoring system in case you are not familiar with it.

• It is scored 0-4

• With each increase in risk factors there is a corresponding increase in the probability of PONV

  • Female Gender 1

  • Non-smoking        1

  • History of PONV 1

  • Post-op opioids 1

Baseline, every individual has a 10% chance of PONV. With 1 risk factor that increases to 20%, 2 risk factors equals 40%, 3 risk factors increases to 60% and 4 risk factors equals 80% chance of having PONV. So, for every risk factor a patient has it is suggested that an intervention be done. That might include 4 different anti-emetics, use of TIVA, opioid sparing technique or any other intervention you have in your tool box!