Post-operative nausea and vomiting (PONV)

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General Management

• Ensure adequate pain control, warmth and comfort
• Correct hypotension, hypovolaemia and hypoxia
• Ensure adequate hydration of the patient
• Ensure that the stomach is not full. A naso-gastric tube may be required. If one is present aspirate it.
• For high risk patients, consider regular anti-emetics for the first 24 hours postoperatively.
• If nausea or vomiting persists, add in a second drug from a different group

High Risk Patients

• History of motion sickness.
• Females of reproductive years.
• Previous history of PONV.
• Patients receiving Opioids.
• After certain operations i.e. Gynaecology, ENT, Ophthalmology.
• Very anxious patients.

Anti-ememtic groups
50mg IV/ IM/Oral
every 8 hours
4mg IV/ IM every 8 hours
8mg Oral every 8 hours
6.6mg IV
as a single dose
12.5mg IM every 8 hours
3 to 6 mgs buccal every 12 hours

Check BNF for contra-indications and side-effects

• Metoclopramide has not been demonstrated to be useful in PONV. It does not have pro-kinetic effects in the presence of opioids and is contraindicated after bowel
Prochlorperazine and Cyclizine should not be used together as they have similar side-effects.
• Ondansetron should always be the first agent of choice.
• Dexamethasone is useful for resistant cases.
• Buccastem® (buccal prochlorperazine) is useful as IM injections can be avoided.
• Caution with cyclizine in the elderly. Consider reducing dose to 25mg.

Editorial Information

Last reviewed: 11 November 2020

Next review: 11 November 2022

Author(s): Acute Pain Team

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Acute Pain Nurse Specialists

Document Id: TAM107