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Effective management of postoperative nausea and vomiting: let us practise what we preach!

There has been much discussion about post-operative vomiting (PONV) in recent decades. Research interest in this annoying complication, which has been referred to as ‘the big little problem’ still continues. The number of commentaries available on this topic is overwhelming and the conclusions are confusing; about 70 editorials have been published in Medline-indexed journals focussing on PONV in a broad sense (http://www.ncbi.nlm.nih.gov/pubmed; limitation: ‘editorial’, search term: ‘PONV’, last access: 9 September 2010). The interested reader can discover the whole history of research into PONV simply by glancing at the titles of these commentaries, written usually by renowned experts in the field. If you believe that these facts render any further engagement in the topic superfluous, you may have missed the point that the big problem today is not PONV per se, but the fact that the overwhelming clinical and experimental evidence is not translated into improved comfort and safety for patients. Therefore, we need to focus on PONV and should heed the problem present today, not because of poor knowledge but because of poor implementation (and lack of a patient-centred approach?).