Postoperative nausea and vomiting in spinal anesthesia

Preventing and treating both postoperative pain and postoperative nausea and vomiting (PONV) are critical for anesthesiologists to promote successful recovery and improve patient outcomes. PONV is a common side effect of anesthesia and surgery, affecting approximately 30% of patients undergoing surgery and up to 80% of high-risk patients [1,2]. Untreated PONV can lead to various complications, including increased risk of postoperative bleeding, delayed wound healing, wound dehiscence, gastric aspiration, and electrolyte imbalances such as dehydration and metabolic disturbances [3]. Additionally, PONV can have a significant impact on the patient???s experience, leading to prolonged hospital stays, increased healthcare costs, and a considerable disruption of daily life [4]. Therefore, the effective management of PONV is crucial to minimize patient discomfort, reduce healthcare costs, and improve overall patient satisfaction and outcomes. Various antiemetic agents have been developed and tested to prevent PONV, including corticosteroids, 5-HT3 receptor antagonists, antihistamines, antidopaminergics, and neurokinin-1 receptor antagonists. Although these agents can be effective at reducing the occurrence of PONV, none is capable of fully preventing PONV owing to the various causes of PONV. Therefore, a multimodal approach involving the use of multiple antiemetic agents with different mechanisms of action along with non-pharmacological interventions such as preoperative fasting, intraoperative fluid management, and the use of regional anesthesia techniques, is often recommended [5]. Furthermore, identifying patients at high risk of developing PONV and initiating preventative measures early can also help to decrease the occurrence of PONV. Recent consensus-based guidelines suggest assessing risk factors (i.e., female sex, postoperative opioid administration, non-smoking status, a history of PONV or motion sickness, young patient age, longer duration of anesthesia, volatile anesthetics, and type of surgery) and reducing the patient???s baseline risk [6]. However, most studies on PONV have primarily focused on patients receiving general anesthesia, and the majority of information regarding PONV risk factors has been derived from this patient population [5,7]. In this issue of the Korean Journal of Anesthesiology, Ju et al. [8] conducted a retrospective analysis of a large cohort of 5,691 patients who underwent orthopedic surgery under spinal anesthesia to determine whether the Apfel score, a tool commonly used to predict the likelihood of PONV based on four risk factors (female sex, history of motion sickness or PONV, non-smoking status, and use of postoperative opioids) remains a valid predictor of PONV during spinal anesthesia. The study found that the Apfel score does remain a valid predictor of PONV after spinal anesthesia and that baseline heart rate, non-smok