Which are Effective options for Prevention of postoperative nausea and vomiting in Thyroidectomy Patients?

Postoperative nausea and vomiting (PONV) represent a major concern in surgical patient care, with incidence rates as high as 30% for the general population and reaching 80% in high-risk groups. Despite existing effective protocols for the management of PONV in the operating room and post-anesthesia care units (PACUs), gaps usually arise when patients transition to wards or intensive care units (ICUs), leading to prolonged recovery periods, increased healthcare costs, and diminished patient satisfaction. To tackle these issues, a novel continuum-based PONV prophylaxis protocol (CBPPP) has been developed, accompanied by a checklist for practical application in clinical settings. The formulation of the CBPPP began with a systematic review of existing guidelines, systematic reviews, meta-analyses, and primary research on PONV prevention. Recent review leveraged extensive databases including PubMed, Cochrane Library, Scopus, and Embase, emphasizing studies from the last decade to ensure contemporary relevance. Contributions from the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting greatly aided the understanding of effective antiemetic pharmacotherapy and perioperative interventions.

Data Synthesis and Collaboration

Data synthesis was meticulously undertaken to map PONV risk factors, evaluate antiemetic strategies, and explore adjunct measures for both intraoperative and postoperative care. This process enabled the development of tailored stratified approaches specific to varying risk profiles among surgical patients. The protocol emerged from collaboration with a multidisciplinary team consisting of anaesthesiologists, surgeons, and clinical pharmacologists. The feedback gathered from this team emphasized critical aspects such as practicality, feasibility, and potential implementation barriers, which were addressed in the final protocol draft.

Structure of CBPPP

CBPPP is structured in four pivotal phases: preoperative, intraoperative, PACU, and postoperative. During the preoperative phase, a thorough risk assessment is conducted, utilizing established criteria such as the Apfel score, which encompasses risk factors like gender, smoking status, history of PONV or motion sickness, and opioid use. Adequate prophylaxis planning is critical, paving the way for a structured approach to managing potential PONV occurrences.

PACU Phase Recommendations

In the PACU phase, the protocol encourages immediate reassessment of the patient’s response to antiemetics upon arrival. A key recommendation includes monitoring for nausea and vomiting within the first 24 hours post-surgery and adjusting prophylactic measures accordingly. This immediate feedback loop is vital for optimizing patient care and minimizing the risk of PONV.

Need for Validation

The development of this protocol does not negate the need for further validation; prospective studies and randomized controlled trials are necessary to adequately evaluate the efficacy and feasibility of the CBPPP in real-world settings. The introduction of a supporting checklist is intended to facilitate the practical application of the protocol within clinical workflows, promoting a standardized approach to PONV prophylaxis.

Goals of CBPPP

Ultimately, the continuum-based PONV prophylaxis protocol aims to enhance patient outcomes significantly, improve recovery times, and increase overall patient satisfaction. This structured and evidence-based approach underscores the commitment to addressing the challenges of PONV management throughout the perioperative continuum, signaling a step towards improved surgical patient care.

Reference –

Singh MP, Gupta A, Bhardwaj S. Continuum based postoperative nausea and vomiting prophylaxis protocol: Development and real world implementation checklist. Indian J Anaesth 2025;69:402-5

Y. Cho et al. (2021). Pharmacologic Interventions For Postoperative Nausea And Vomiting After Thyroidectomy: A Systematic Review And Network Meta-Analysis. *PLoS ONE*, 16. https://doi.org/10.1371/journal.pone.0243865