Nausea and Vomiting After Surgery

Anesthesia is by far the most common cause of nausea and vomiting after surgery. But there may be other reasons for postoperative nausea and vomiting (PONV), a condition that affects around 30% of people who undergo surgery. These include dehydration, a history of motion sickness, and taking medications on an empty stomach.

PONV can also cause dehydration as well as other complications such as incisional pain, esophageal rupture (a tear in the esophagus which carries food to the stomach), and wound dehiscence (the opening of the incision).

This article explains why nausea after surgery occurs along with vomiting and what can be done to prevent or treat this common postoperative condition. It also describes the signs and symptoms that warrant an immediate call to your surgeon or ER department.

Common Post-Op Nausea Symptoms

PONV is a common complication that is usually not serious and typically resolves on its own or with antiemetic (anti-nausea) medication. Even so, many people rate PONV as being worse than even postoperative pain.

Studies suggest that up to 40% of people experience nausea following surgery, while roughly 30% will experience vomiting or retching (dry heaving).

The term PONV describes nausea and/or vomiting in the post-anesthesia care unit (PACU) of a hospital or within 24 hours of undergoing inpatient surgery. Postdischarge nausea and vomiting (PDNV) refers to symptoms that occur 24 to 48 after discharge from an outpatient surgical procedure, including dental surgery.

It can be normal for nausea to last anywhere from a few hours to a few days after surgery. However, vomiting for more than 24 hours is a cause of concern warranting immediate medical attention.

Complications of Nausea and Vomiting After Surgery

Feeling nauseous after surgery is not only uncomfortable, but it can also slow your return to normal eating and drinking. Vomiting is a more serious concern due to the rapid loss of body fluids and the physical stress it can place on incisions, particularly those around the abdomen or chest.

Possible complications of PONV include:

• Dehydration
• Wound dehiscence (when the edges of an incision separate)
• Evisceration (the complete opening of a wound)
• Esophageal rupture
• Aspiration pneumonia (pneumonia caused by the inhalation of vomited contents into the lungs)
• Increased intracranial pressure (pressure within the skull)
• Pneumothorax (a collapsed lung)

Complications can get progressively worse the longer PONV symptoms persist.

Why Is Nausea Common After Surgery?

PONV is a known risk factor of anesthesia, but certain types are more likely to cause nausea and vomiting than others. Volatile anesthesia, the type administered as a gas (such as with nitrous oxide), is 13 times more likely to cause PONV than intravenous anesthesia delivered into a vein (like propofol).

The duration and dose of anesthesia also play a part. Studies suggest that surgeries lasting longer than 30 minutes increase the risk of PONV by no less than 60%.

The risk of PONV is also greater with certain types of surgery. These include gastrointestinal, ear, intracranial, and gynecological surgeries as well as laparoscopic surgery (also known as "keyhole surgery.")

Contributing factors of PONV and PDNV include:

• Dehydration
• Taking medications on an empty stomach after surgery
• Returning too quickly to a normal diet after surgery

Treatment

If a person gets PONV, medications can be prescribed to help ease the symptoms. There are also certain dietary or lifestyle modifications that can help you recover at home.

In-Hospital Care

There are a number of medications that can be used alone or in combination to treat PONV. Some directly ease nausea symptoms, while others ease contractions that contributed to vomiting.

These include:

• Antiemetics like Zofran (ondansetron), Inapsine (droperidol), and Reglan (metoclopramide)
• Antihistamines such as Dramamine (dimenhydrinate)
• Steroids such as dexamethasone

Oral and/or intravenous fluids may be also given to treat dehydration and normalize your electrolyte balance.

At-Home Care

Oral medications like Zofran and Dramamine can also be prescribed if you develop PDNV. These are typically used for a couple of days until symptoms ease.

To support treatment, some studies suggest ginger (in the form of fresh ginger, ginger tea, ginger candy, or flat ginger ale) is effective in easing symptoms of PONV and PDNV.

Other experts suggest that electrolyte drinks, apple juice, and popsicles can help ease PDNV symptoms while ensuring ample hydration.

Prevention

With proper planning and communication, you and your medical care team can prevent nausea and vomiting after surgery.

Prophylactic Medications

If you have chronic nausea or you've had PONV before, you're at risk of having it again. In such cases, your care team may prescribe prophylactic (preventative) medications such as:

• Zofran (ondansetron)
• Phenergan (promethazine)
• Benadryl (diphenhydramine)
• Emend (aprepitant)
• Scopolamine transdermal patch

Keep Hydrated

Staying hydrated before and after surgery can help prevent PONV. You need to stay away from food and non-clear liquids for safety reasons. But anesthesiologists sometimes okay clear fluids closer to the time of surgery.

Dehydration can be a problem after procedures, as well. Drinks containing electrolytes can help hydrate you more quickly than other beverages. If you're recovering at home, have a sports drink or Pedialyte. If you're in the hospital, ask the nurse for something with electrolytes. 

Manage Your Pain

Don't skip your pain medication because you're nauseous. You may be concerned that the drugs will make you sick, but research suggests pain makes you more likely to vomit. Pain control can make it less likely.

Don’t Rush Your Diet

Slowly return to normal foods to minimize nausea. With some surgeries, like gastrointestinal surgeries, you don't get to eat until you're passing gas.

After that, stick with small amounts of clear fluids. If they don't bother you, try to drink some juice or milk. Assuming you're still doing well, you may be able to introduce some soft foods like applesauce or pudding. Keep it slow and easy though, following the dietary routine offered by the care team.

Be Aware of Temperature

Some people are sensitive to the temperature of fluids. If cold drinks tend to bother your stomach, ask for room-temperature or warmer drinks. If hot drinks are a problem, ask for cooler options. 

Getting overheated can also make some people nauseous. If you're feeling overly warm, do what you can to cool off.

Avoid Strong Smells

Avoid heavily scented people and places if you're prone to nausea after anesthesia. For hospital stays, tell your care team that you are sensitive to fragrances. Ask people who may visit you to skip body sprays, perfume, and other fragranced products. You can also request foods with mild smells.

When to See a Healthcare Provider

Nausea and vomiting that occurs more than 24 hours after surgery should never be considered normal. If symptoms persist or worsen, call your surgeon or healthcare provider immediately.

On the other hand, call 911 or go to your nearest emergency room if you develop the following signs and symptoms after returning home from surgery:

• Vomiting for longer than 24 hours
• Inability to keep down fluids for 12 hours or more
• Severe unrelenting headache and/or stiff neck
• Inability to urinate
• Signs of severe dehydration (sunken eyes, intense thirst, dark urine, lightheadedness)
• Bloody vomit
• Rapid, labor breathing
  
• High fever with chills
• Cloudy or foul-smelling discharge from the wound
• An opening incision with bleeding or fluid drainage
  

Summary

Postoperative nausea and vomiting (PONV) affect around 30% of people who undergo surgery. It is commonly associated with anesthesia, especially volatile anesthesia delivered as a gas. PONV is more common with digestive, gynecological, ear, intracranial, or laparoscopic surgeries, or with surgeries that last longer than 30 minutes.

Preventive medications may be prescribed for people at risk of PONV. For people who develop PONV, anti-nausea drugs can help ease symptoms. If left untreated, PONV may lead to severe dehydration, esophageal bleeding, and surgical site complications such as infection, prolonged healing, or reopening of the incision.