Enhanced recovery programs depend greatly on the ability to support patients with early nutrition, multimodal analgesia and ambulation, none of which can be achieved unless the GI tract is functioning well. PONV prophylaxis begins in the operative room. Laparoscopic surgery may increase the risk of PONV while adequate hydration and opioid minimization are protective. A simple risk calculator like the Apfel score should be used to identify patients at higher risk and a tailored strategy applied for patients at moderate or high risk, with at least two modalities used for high risk patients (1).
For more information, see Chapter 8: Prevention of Postoperative Nausea and Vomiting in The SAGES / ERASÂ® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery
1. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, TramÃ¨r MR; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 Jan;118(1):85-113