Management of postoperative nausea and vomiting

The management of postoperative nausea and vomiting is a core task of a junior doctor on a surgical firm. Indeed, nausea and vomiting is one of the most common and unpleasant complications of admission for a surgical procedure. Unfortunately, this common condition is often managed ineffectively.

To accurately quantify the number of patients affected is difficult, because it is often under-reported, but research has shown that as many as 30% of patients develop postoperative nausea and vomiting.1 Nausea and vomiting may be part of the natural history of disease; or be due to the side effects of drugs, particularly analgesics; or be the result of the effect that hospital admission can have on sleeping and diet. Patients who are young and female, and those undergoing bowel or gynaecological surgery, have been shown to be particularly at risk.1

Nausea and vomiting is mostly not life threatening and is always self limiting; this may explain why it is under-reported. Be aware, however, that any patient vomiting after abdominal surgery, when coughing is difficult, risks aspiration. Other serious complications known to be associated with nausea and vomiting include suture dehiscence, oesophageal rupture, gastrointestinal bleeding, and pneumothorax.2

Nausea and vomiting can be notoriously difficult to treat. It is therefore essential that a range of non-pharmaceutical therapies are employed with antiemetic drugs when confronted with a nauseous or vomiting postoperative patient.