Enhancing the management of postoperative nausea and vomiting: from genetics and pharmacology to daily practice

Many patients experience nausea and vomiting after surgery, which can be very uncomfortable and may delay recovery. Despite preventive medications, this problem remains common, particularly in women, non-smokers and those with a previous history of postoperative nausea and vomiting (PONV). Our research aimed to improve PONV prevention for a quicker, and more comfortable recovery.

We identified groups more likely to experience PONV, focusing on clinical factors, ethnicity and genetics. Notably, a specific gene (the C allele of P2RX7) may protect against vomiting. We also confirmed that individuals with a prior PONV or motion sickness are at a higher risk of experiencing it again. These insights could guide more personalised PONV prevention strategies in the future.

Our study also evaluated medicines like olanzapine, aprepitant, and fosaprepitant. Combining certain drugs significantly reduced PONV, while others were less effective. Olanzapine, typically used for mental health conditions, worked well alongside standard treatments, significantly lowering the chances of PONV. However, aprepitant, a drug specifically approved to prevent PONV, did not show much benefit when combined with another drug called palonosetron. After reviewing available studies, we concluded that while these medications help prevent PONV, their effectiveness depends on how they are combined.

Overall, our findings suggest that we can enhance the prevention of these unpleasant side effects by understanding patient’s individual risk factors and using a combination of medications targeting different factors contributing to PONV. These insights can help improve patient care by making recovery from surgery more comfortable and reducing the risk for complications.