Figure 3:

Clinical evidence for treating post-operative nausea and vomiting

Despite prophylactic peri-operative treatment with anti-emitics, many patients experience post-operative nausea and vomiting (PONV).

Evidence-based guidance for the treatment of PONV is needed.

Analysis of 46 studies in patients with PONV
Clinical outcomes after administration of PONV prophylaxis and/or rescue medications assessed
Evidence summarised into a treatment algorithm

Recommended anti-emitic algorithm for patients experiencing PONV:

Dopamine antagonists

e.g. amisulpride (10 mg) and droperidol (1 to 1.25 mg)
5-HT₃ antagonists

e.g. ondansetron (4 mg)
Histamine antagonists

e.g. diphenhydramine (12.5 mg)

(20 mg bolus)
In case of failure of prophylaxis, medications from the prophylactic drug class should be excluded Ondansetron is the drug of choice in patients who have not received prior prophylaxis
Combination therapy is more effective for PONV prophylaxis as well as rescue
Additional studies are needed to guide treatment of PONV, especially in patients who have experienced failure of prophylaxis

Source: adapted from Gan TJ, Meyer TA. Systematic review article: rescue treatment of postoperative nausea and vomiting: a systematic review of current clinical evidence. Anesth. Anala. 2022; 135(5):986-1000.