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Does the Routine Prophylactic Use of Antiemetics Affect the Incidence of Postdischarge Nausea and Vomiting following Ambulatory Surgery?: A Systematic Review of Randomized Controlled Trials

THE rapid increase in ambulatory surgery procedures performed over the past 10 yr has resulted in greater focus directed toward the control of postoperative nausea and vomiting (PONV), sometimes appropriately termed the “big, little problem.” The incidence of this complication is variable, but PONV has emerged as one of the commonest complications following ambulatory surgery, and the one that patients would most like to avoid. Specifically, the postdischarge period has been poorly studied but is important from the patient’s perspective. Despite the increasing availability of newer and more expensive drugs for the prevention of PONV, some authors question the routine use of single-drug prophylaxis in low-risk patients. The long-term ( 6 h) effect of antiemetics is even more uncertain in the ambulatory setting, because the focus of attention has previously been on the management of early PONV (in the day surgical unit). As many as 35–50% patients continue to have postdischarge nausea and vomiting (PDNV). It is important to control this symptom after discharge, because resumption of normal activities may be delayed if PONV is prolonged and ambulatory surgical patients are not under direct medical supervision after discharge. In our experience, few centers routinely provide antiemetics for the control of PDNV at home. Numerous systematic reviews have now been published in the literature on PONV, but only one has focused on PONV after hospital discharge in ambulatory surgical patients. This systematic review was completed to address the question of whether the routine prophylactic use of antiemetics affects the incidence of PDNV following ambulatory surgery. We restricted our analysis to randomized, controlled studies published in the English literature.