Update on the management of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) continues to be one of the most common postsurgical medical problems. An understanding of the pathophysiology of PONV and the pharmacological profiles of agents affecting receptors involved in emesis is necessary to effectively treat PONV.

Although serotonin receptor antagonists remain key in the multimodal approach to PONV management, new research developments involving antiemetics, such as neurokinin-1 antagonists, corticosteroids, dopamine antagonists, and cholinergic antagonists, have yielded valuable efficacy and safety information.

Proper management of PONV includes an evaluation of risk factors, a strategy for prophylaxis, and rescue antiemetic treatment if necessary. In high-risk patients, combination therapy is recommended in preventing PONV. Knowledge of antiemetic efficacy and safety may facilitate an increase in patient satisfaction, decreased negative health consequences, and reduced medical costs.