Post-Operative Nausea and Vomiting
BNF Treatment summaries Nausea and labyrinth disorders.
NHS Scotland NHS Borders guidelines for managing postoperative nausea and vomiting in adult patients. Last revised: Feb 2022.
Risk Factors
Risk factors for post-operative nausea and vomiting include:
| Patient factors |
|
| Surgical factors | Certain types are surgery are at higher risk:
|
| Anaesthetic factors | Use of:
*Propofol is protective against post-operative nausea and vomiting due to its anti-emetic properties |
| Post-operative factors |
|
Prophylaxis
Exact prophylactic indications and components varies depending on local practice, however the general consideration is as following:
- Patients with no risk factors → prophylaxis given post-operatively
- Patients with risk factors → prophylaxis given intra-operatively and post-operatively (or even pre-operatively for high risk patients)
Treatment
BNF recommends a combination of 2 antiemetic drugs with different mechanisms of action in those with risk factors for post-operative nausea and vomiting.
There are no clean-cut guidance on which drug is preferred over which, thus the choice is mainly influenced by cautions and contraindications (in practice it would depend on local guidelines):
| Drug class | Licensed drugs | Key caution / contraindications |
|---|---|---|
| Anti-histamine | Cyclizine |
|
| 5-HT3 receptor antagonist | Ondansetron
Granisetron |
|
| Dopamine antagonists | Haloperidol
Droperidol Prochlorperazine |
|
| Glucocorticoid | Dexamethasone |
|
Cyclizine is specifically licensed for post-operative nausea and vomiting caused by opioids and general anaesthetics)
Step up: if a drug failed to control symptoms → switch to a different class of antiemetic.
In patients with Parkinson’s disease / Parkinsonism, the drug of choice is 5-HT3 receptor antagonist (e.g. ondansetron, granisetron).
Dopamine antagonists should NOT be given, with the exception of domperidone (which does not readily cross the BBB, however it is not licensed to treat post-operative nausea and vomiting)