Undergoing surgery can be a nerve-wracking experience, but for many patients, the discomfort doesn’t end when the procedure is over. Postoperative nausea and vomiting (PONV) are common side effects of anesthesia, affecting up to 30% of surgical patients—and even more in high-risk groups. While anesthesia plays a crucial role in ensuring a painless and safe procedure, its effects on the body can linger, sometimes leading to waves of nausea that make recovery more challenging.
Understanding why anesthesia causes nausea, who is most at risk, and what strategies can help prevent or manage this unpleasant side effect is key to improving patient comfort and recovery outcomes. Gara Knudtson, Doctor of Nurse Anesthesia Practice and certified registered nurse anesthetist with Pullman Anesthesia at Pullman Regional Hospital, offers helpful information and advice.
What causes postoperative nausea and vomiting?
Per Knudtson, the anesthetic gases used are the main “offenders” when it comes to PONV. This is especially true among patients undergoing general anesthesia, who tend to receive inhalation agents as well as narcotic anesthesia; they are just more prone to the experience of PONV. She also explains who else might be more susceptible to PONV.
“This would include patients with a history of motion sickness, non-smokers—which, side note, this is not me advocating for people to smoke or to continue smoking by any means—patients undergoing laparoscopic surgeries, gynecological procedures, and especially laparoscopic gynecological procedures,” she states. “We tend to see younger patients, younger than middle age, be more prone to postop nausea and vomiting as opposed to our more elderly population.”
How can postoperative nausea and vomiting be prevented?
There are a few strategies patients can employ to reduce the chance of PONV. Be sure to inform your nurse anesthetist on the morning of surgery if you have a history of PONV or motion sickness. While this information is often in your health records, discussing it in the preoperative area ensures everyone is aligned. To minimize or prevent nausea, anesthetists use a combination of anti-nausea medications and adjustments to the anesthetic approach.
“One of the main things we do is called a TIVA or a total IV anesthetic. What that does is allow us to completely eliminate our inhalation agent, which is our main hitter when it comes to causing postoperative nausea and vomiting. So, we get people off to sleep with medicine in their IV, and then we use that same medicine, propofol, to keep them sleepy for the remainder of their surgery,” notes Knudtson.
Scopolamine patches are effective for many in preventing nausea, but they can cause side effects like dry mouth or blurred vision. However, not everyone experiences these side effects. “If you're interested in using a scopolamine patch or if you've had success with a scopolamine patch in the past, definitely let us know. We're happy to order those. They are great because they can stay on for three days,” she adds. “So, with that extended postoperative period you get a little extra anti-nausea treatment.”
How long can postoperative nausea and vomiting last?
The duration and severity of postoperative nausea depend on the anesthetic drugs used and the length of the procedure. Some medications clear from the system within 10–15 minutes, while others can last for hours. Most cases of nausea resolve within a few hours due to anti-nausea treatments, with additional rescue medications available if needed. While lingering effects for a week are uncommon, patients with kidney or liver dysfunction may metabolize anesthetics more slowly, potentially experiencing side effects for several days.
“I know there is a fair amount of anxiety that comes along with having surgery, especially if you've had a bad outcome in the past in terms of pain or postoperative nausea and vomiting. I've had countless patients tell me they would rather have pain postoperatively than be nauseous,” shares Knudtson. “I just want to reiterate, make sure you let your nurse anesthetist know day of surgery if you have had a bad experience in the past with nausea, and we will do everything we can to make sure you wake up comfortably.”