What is postoperative vomiting and nausea? A comprehensive guide.

September 28, 2025 •

2 min read

Up to 30% of surgical patients experience postoperative nausea and vomiting (PONV), a common side effect of anesthesia and surgery. Understanding what is postoperative vomiting and nausea is crucial for anticipating and managing this discomfort for a smoother recovery.

Quick Summary

Postoperative nausea and vomiting (PONV) is a common side effect that occurs after a surgical procedure and can be triggered by anesthesia, pain medication, or the surgery itself. Symptoms can range from mild discomfort to severe retching, impacting a patient's comfort and recovery.

Key Points

Definition: Postoperative nausea and vomiting (PONV) is the experience of nausea or vomiting within the first 24-48 hours after a surgical procedure.
High Incidence: PONV is a very common complication, affecting up to 30% of general surgical patients and 80% of high-risk individuals.
Risk Factors: Risk is increased by factors including female gender, non-smoking status, a history of motion sickness, and the use of general anesthesia or opioids.
Multimodal Management: The most effective approach involves using multiple strategies, such as prophylactic antiemetics and opioid-sparing techniques, tailored to a patient's risk level.
Serious Complications: While often mild, severe PONV can lead to dehydration, delayed discharge, and, in rare cases, wound dehiscence or aspiration pneumonia.
Rescue Therapy: If preventive drugs fail, rescue antiemetics from a different pharmacological class should be administered for better therapeutic effect.

Understanding the Triggers: What Causes Postoperative Nausea and Vomiting?

Postoperative nausea and vomiting (PONV) involves the nervous system, with neurotransmitters influencing the vomiting center.

Patient-Related Causes

Patient factors increasing PONV risk include gender, history of motion sickness or previous PONV, non-smoking status, and age.

Anesthesia-Related Causes

Anesthetic choices impact risk; general anesthesia, especially with volatile gases, and opioid use are factors. Total Intravenous Anesthesia (TIVA) with propofol may reduce risk.

Surgical-Related Causes

Longer procedures and certain surgery types, such as laparoscopic or abdominal, are associated with higher PONV rates.

Risk Identification and Management

Assessing risk pre-operatively, for example, using the Apfel Simplified Risk Score (SRS), helps implement strategies for management.

Common Complications of Postoperative Nausea and Vomiting

Severe PONV can lead to dehydration, electrolyte imbalance, wound dehiscence, aspiration pneumonia, and potentially increased intracranial pressure.

Preventing and Treating Postoperative Nausea and Vomiting

Prophylactic Measures

Preventive measures include multimodal antiemetic therapy, alternative anesthetic techniques like regional anesthesia or propofol-based TIVA, opioid-sparing analgesia, and hydration.

Rescue Treatment

If prophylaxis fails, rescue medication from a different drug class is used. Non-pharmacological aids like aromatherapy or acupressure may offer relief.

Comparative Table of Antiemetic Drug Classes for PONV


Drug Class	Examples	Mechanism of Action	Common Side Effects
5-HT3 Antagonists	Ondansetron, Palonosetron	Block serotonin receptors	Headache, constipation
Corticosteroids	Dexamethasone	Anti-inflammatory properties	Increased blood glucose
Dopamine D2 Antagonists	Droperidol, Amisulpride	Block dopamine receptors	Sedation, dizziness, prolonged QTc interval (droperidol)
NK-1 Antagonists	Aprepitant	Block substance-P receptors	Headache, fatigue

Alternative and Natural Remedies

Natural methods like ginger, peppermint, a bland diet, and controlled breathing may help mild nausea.

Conclusion: Ensuring a Smoother Recovery

Managing postoperative vomiting and nausea involves identifying risk factors and using personalized approaches. More detailed information on PONV is available from authoritative medical resources such as {Link: National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK500029/}.

Frequently Asked Questions

For most patients, PONV symptoms are most common within the first 24-48 hours and typically resolve gradually within 3-5 days. Persistent or worsening symptoms beyond this point should be reported to a doctor.

Yes, key risk factors include female gender, a history of motion sickness or previous PONV, non-smoking status, younger age, and the use of general anesthesia or opioids during or after surgery.

Causes include the effects of anesthesia, particularly volatile gases; opioids used for pain management; the type and duration of surgery; and patient-specific factors like anxiety or a history of motion sickness.

Natural remedies like ginger, peppermint aromatherapy, and slow, deep breathing can help with mild nausea. Maintaining adequate hydration and eating small, bland meals can also be beneficial.

Prevention strategies include using a multimodal approach with prophylactic antiemetic drugs from different classes, favoring total intravenous anesthesia (TIVA) with propofol, minimizing opioid use, and ensuring proper hydration.

Severe PONV is treated by administering a rescue antiemetic from a different pharmacological class than any prophylactic drugs used. Reassessment of the patient, hydration, and correcting electrolyte imbalances are also crucial steps.

You should contact your healthcare provider if nausea persists beyond five days, vomiting is severe or persistent, you are unable to keep fluids down, or if you show signs of dehydration.

Yes. General anesthesia carries a higher risk than regional anesthesia. Furthermore, using a propofol-based TIVA (total intravenous anesthesia) is less likely to cause PONV than using volatile anesthetic gases.