Management of Postoperative Nausea and Vomiting in Women Undergoing Major Gynecological Surgery: A Review and Update

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events associated with anesthesia and surgery, with a high incidence after major gynecological surgery (e.g., abdominal hysterectomy). Numerous antiemetics have been studied for the prevention and treatment of PONV after this surgical procedure. Most of the published trials indicate the improved prevention of PONV by avoiding risk factors and/or by using antiemetic therapy in women undergoing major gynecological surgery. Pharmacological approaches include phenothiazines (e.g., perphenazine), butyrophenones (e.g., droperidol), benzamides (e.g., metoclopramide), antihistamines (e.g., cyclizine), proppofol, dexamethasone, ephedrine, serotonin receptor antagonists (e.g., ondansetron, granisetron) and neurokinin-1 receptor antagonists (e.g., aprepitant). None of the currently available antiemetics is entirely effective, perhaps because most of them act through the blockade of one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone preventing PONV. Combination antiemetic regimens (e.g., ondansetron plus droperidol) are highly effective in the prevention of PONV. As non-pharmacological therapy, acupressure and acupuncture at the P6 (Nei-Kuwan) point are effective for preventing PONV. For the treatment of established PONV, granisetron is more effective than droperidol or metoclopramide. In the management of PONV after major gynecological surgery, the benefits and risks of these clinical strategies should be considered.