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Post-operative nausea and vomiting: do they matter?

Post-operative nausea and vomiting (PONV) has been described as the 'big little problem'. With the marked improvement in anaesthetic-related mortality and life-threatening morbidity, attention has increasingly focused on the control of post-operative pain and emetic symptoms. While much effort has been rightly centred on attempts to reduce post-operative pain, not enough attention has been given to the management of PONV. Yet many patients consider this complication to be as debilitating as the pain associated with the surgical procedure. With the advent of newer drugs such as the anti-serotonin agents (e.g. ondansetron and granisetron), propofol and eltanolone, parenteral non-steroidal anti-inflammatory agents and rapid, shorter-acting neuromuscular blocking drugs that do not require routine antagonism, the incidence of emesis has been decreased. Abolition of the requirement that patients drink liquids prior to discharge from the ambulatory care centre has also helped to reduce PONV.