Treating Nausea and Vomiting After Surgery

Postoperative Nausea and Vomiting (PONV) is the most common complication that patients face after surgery. Nausea and vomiting can be a serious problem, and it is often made worse by the medications used during a hospitalization. Anesthesia medications, in particular, are known for their nausea-inducing side effects. The combination of surgical incision pain and vomiting should be avoided at all costs, as it is very unpleasant and can put a great deal of stress on your surgical site.

Risk Factors

General anesthesia is a significant risk factor for nausea and vomiting after surgery. If you are prone to vomiting after surgery, you may want to inquire if it is possible for you to have IV anesthesia, rather than volatile gases. The inhaled type of anesthesia medications are known to cause more nausea than the type given by IV.

The type of surgery is also known to contribute to nausea and vomiting. Minimally invasive procedures, surgeries involving the face and head, abdominal surgeries, surgeries on the urinary tract and surgeries on the reproductive organs are known to have higher rates of PONV than other procedures.

Men tend to have nausea and vomiting after surgery less than female patients, and younger patients tend to experience more than older patients. Individuals who are prone to motion sickness have much higher rates of nausea, as do non-smokers. The patient who has had prior bouts of postoperative nausea and vomiting with a previous surgery is far more likely to have it than the average patient.

A tool called the Apfel Scale is often used to determine if a patient is likely to have nausea and vomiting after surgery. There are four questions on the scale:

• Is the patient female?
• Is the patient a non-smoker?
• Does the patient suffer from motion sickness?
• Is opioid pain medication part of the recovery plan?

For each yes answer, the patient is given a point, with four being the maximum number of points. A patient with one point has a 10% chance of postoperative nausea and vomiting, a patient with four points has a 78% risk. This score will help the anesthesia provider decide if preventative medication should be given during or immediately after surgery. If you score above 2 on this scale, you may want to let your anesthesia provider know that you are at risk for nausea and vomiting after surgery.

Prevention

For some patients, the anesthesia provider will pre-medicate for nausea and vomiting, meaning that they will give anti-nausea medication before the patient has any symptoms. This is most frequently done when the patient has had a surgery that is prone to complications when vomiting occurs. For example, patients with a large abdominal incision can have a very serious complication called dehiscence and evisceration if prolonged vomiting occurs. The medication used to treat nausea is often more effective at preventing nausea than reducing nausea after it occurs.

Returning to a regular diet should be done in steps. The first step is typically sucking on ice chips, if this can be done successfully, the patient will start with clear liquids, then a full liquid diet, followed by a soft food diet and finally a regular diet. Individuals with specific needs, such as a diabetic diet, would have soft diabetic friendly foods, in keeping with their dietary needs.

Treatments

Zofran (ondansetron): This medication can be given through an IV or as a pill for the prevention or treatment of nausea and vomiting.

Phenergan (promethazine): This medication is typically given for nausea and vomiting, and can be given IV, orally as a pill or syrup, as a suppository, or as an injection into a muscle. It is known to have a side effect of sedation, making most patients sleepy.

Reglan (metoclopramide): This medication is given to increase the action of the intestines, as they are often sluggish after anesthesia, and this can result in nausea and vomiting. It is given as a pill or through an IV.

Compazine: This medication is used for multiple issues, but is known to reduce nausea and vomiting in the surgery patient. It can be given as an injection into a muscle, through an IV, as a pill or suppository. It can also reduce anxiety.

Scopolamine: This medication is used for motion sickness as well as postoperative nausea and vomiting. It can be applied as a patch, given through an IV or as an injection.

IV fluids: For some people, just being well hydrated can reduce nausea and vomiting. For others, the process of vomiting can quickly lead to dehydration. IV fluids are typically used along with a medication for the treatment of nausea and vomiting.

Nasogastric tube: For severe vomiting, a nasogastric tube may be placed into the stomach. This tube is inserted into the nose (or mouth if the patient is on a ventilator), into the esophagus and down into the stomach. The tube is attached to a suction device which gently applies suction to the tube, removing the contents of the stomach.