Nausea and Vomiting After Surgery

Postoperative nausea and vomiting (PONV) is an enormous problem for patients recovering after surgery. About 30% of people experience vomiting and 50% experience nausea. As many as 80% of high-risk individuals may experience postoperative nausea and vomiting.

Feeling nauseated after surgery is uncomfortable and can dramatically slow the return to normal activities like eating and drinking. Vomiting is more serious, as it can be very painful after surgery and can put large amounts of stress on some surgical incisions, leading to major complications like dehiscence and evisceration, dehydration, and more.

Regardless of how or why nausea and vomiting begin, quick action may help prevent more serious issues. With quick treatment, nausea can often be prevented from turning into an episode of vomiting.

While nausea and vomiting after surgery is a known risk of anesthesia, there are other factors that can play a role, such as dehydration, medications being given on an empty stomach, an overly aggressive return to a normal diet, and a lack of preventative nausea and vomiting medication.

Research has also found that women, people over age 50, non-smokers, and those prone to motion sickness are more likely to experience nausea and vomiting after surgery.

The type of anesthesia also plays a role. A patient having sedation for a dental procedure or an outpatient procedure such as a colonoscopy will have less anesthesia medication for a shorter amount of time than the average surgery patient. 

The same is true of other outpatient surgeries, such as a colonoscopy, biopsy or other procedures that are typically over quickly and done with the intention of the patient recovering at home.

For some patients, nausea and vomiting after surgery is something they experience every time they have anesthesia. For these patients, in particular, preventing the problem is of great importance. This may mean medications being given prior to and even during surgery, so they are in full effect once the surgery is completed. 

For patients with chronic nausea, the feeling is something they experience on a daily basis, with or without anesthesia medications. These individuals are at a far higher risk of having nausea and/or vomiting after a procedure because they may start the day feeling the urge to vomit and find that it is worsened by anesthesia medications. 

One way to prevent PONV is to prevent dehydration. With the anesthesiologist’s blessing, many patients are able to drink clear liquids up until the hours immediately before surgery without complications. Food and non-clear liquids are still not appropriate prior to surgery, but some clear fluid intake may help prevent nausea and vomiting.

Reporting nausea as soon as it occurs is important, and even more importantly, tell the team if you have a history of nausea after surgery before you receive anesthesia. A history of experiencing these symptoms after procedures means you have a higher risk of nausea and vomiting again. Your nurse should be made aware of the issue if you are in the hospital, your surgeon should be told if you are recovering at home. Medications can be prescribed to help decrease nausea and, hopefully, prevent vomiting if your care team is aware of the issue.

Another method requires a discussion with anesthesiology regarding previous episodes of nausea and vomiting after surgery. If the problem is known, the anesthesia provider can choose anesthesia medications that are less likely to cause nausea and vomiting. They can also provide preventative medications such as ondansetron (Zofran), promethazine (Phenergan) or diphenhydramine (Benadryl). These medications can also be used once nausea is present or be given as a preventative.

Medications can be given to prevent nausea before it happens. Some surgeons routinely include anti-nausea medications in postoperative orders to minimize the problem. If you have experienced nausea and vomiting in the past, be sure to let your care team know so that preventative measures can be taken.

Don't skip your pain medication because you are feeling nauseated if you can help it. Pain control can help decrease the incidence of nausea and vomiting after surgery. 

When possible, treating pain effectively can also be a treatment for nausea. Research suggests that a multimodal approach to pain management can be effective for keeping pain in check and minimizing any postoperative nausea and vomiting.

A slow return to normal foods is an ideal way to minimize nausea. After surgery, the diet typically starts as nothing by mouth until the patient passes gas. Once the patient is able to pass gas, clear fluids in small amounts should be tried over the course of a few hours to ensure that they won’t induce nausea or vomiting. 

If clear fluids are tolerated, other liquids such as juice, tea, milk, and coffee may be introduced. If these are tolerated, a soft diet of foods such as applesauce or pudding is next, with a full diet being introduced only when the others were successfully tolerated. 

This process of advancing the diet is often done over the course of several days if the surgery was a major one. A slow progression is a key to success.

Some patients are very sensitive to the temperature of fluids. They may tolerate room temperature fluids or warm fluids well, but cannot tolerate cold drinks. The opposite may also be true. 

Oddly enough, being overheated can also be an issue. Finding a cool place to rest, rather than being in a hot room or outdoors on a hot day, can provide relief for some.

Ginger ale that has been allowed to go flat has been found to be soothing to the stomach and can often be used as a treatment for nausea. Beware, fully carbonated drinks can make the stomach feel bloated and can contribute to nausea. Also, check the label to make sure that the drink contains real ginger and not just imitation flavoring.

Ginger, in general, has been shown to help nausea, so ginger candy and other types of ginger foods can be of use, as long as they have real ginger as an ingredient, not ginger flavoring. Some people make tea with fresh ginger and drink it hot or over ice for relief. 

If dehydration is a problem, drinks with electrolytes in them may help return the body to normal more quickly than other beverages. Water is always going to be important and is the first choice in most situations, but electrolytes are often lost with vomiting and diarrhea and may need to be replaced.

There are many types of electrolyte replacement drinks, ranging from Gatorade to Pedialyte that can help restore the body's fluids and electrolytes at the same time. Again, avoid carbonated beverages as they can cause issues with nausea and vomiting.

Avoid heavily scented rooms (and people!) if you are prone to nausea after anesthesia. That may mean avoiding restaurants, kitchens, individuals who wear perfume and other types of scents that might normally not be a problem. 

Prevention is incredibly important when it comes to postoperative nausea and vomiting (PONV) because it is far easier to prevent nausea than to treat nausea. If you have had nausea in the past, tell your anesthesia provider. If you start to experience nausea after surgery tell your nurse or anesthesia provider right away, because it may get worse before it gets better. 

When treating nausea the unfortunate truth is that the worse it is the harder it is to control so don't wait to ask for medication when it happens.