Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

Abstract

Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.

Combination of dexamethasone and ondansetron in prophylaxis nausea and vomiting in gynecological operation

“…4 The current published articles dealing with the issue of postoperative vomiting and nausea in women undergoing gynecological operations are extremely inconsistent concerning management, prediction, incidence, and risk factors. 8 ondansetron groups (P < 0.05). The rate of nausea in combined group was significantly lower than that of dexamethasone and ondansetron groups.…”

“…4,7 Gynecological and obstetrical operations are among the most frequent types of surgeries associated with nausea and vomiting postoperatively. 8 Nausea and vomiting occur in about 80-95% of women who are administered low dose of prophylactic antiemetic medication within the first 24 h following surgery. 8,9 It has been shown that female gender and gynecological operations are among the strong predictors of postoperative vomiting.…”

“…8 Nausea and vomiting occur in about 80-95% of women who are administered low dose of prophylactic antiemetic medication within the first 24 h following surgery. 8,9 It has been shown that female gender and gynecological operations are among the strong predictors of postoperative vomiting. [10][11][12] Due to the misery caused by the vomiting, including electrolyte imbalance, wound dehiscence, and the additional costs required due to delayed discharge, this has significant psychological, physical, emotional, and financial repercussions.…”

“…13,15 Ethnicity, pharmacogenomic pleomorphism, psychosocial factors, and sex hormone levels may be associated with increased risk of postoperative incidence of nausea and vomiting according to some authors. 8 The use of dexamethasone as a pharmacological agent with documented role in prevention and reduction of impact of postoperative nausea and vomiting has been discussed by several authors previously; [16][17][18] however, its use has also been discouraged by some authors because of the possible side effects. 19 Among the list of other pharmacological agents that has been used as a prophylactic measure for postoperative nausea is the 5HT3 antagonist (ondansetron).…”

Comparison of anaesthesia‐related outcomes in patients monitored by newly recruited nurse anaesthetists and anaesthesiologists: An observational study

“…Female sex was an independent risk factor for PONV, and carbon dioxide pneumoperitoneum and Trendelenburg positioning were risk factors for PONV in gynaecological surgery; therefore, the incidence of PONV in gynaecological surgery was high in this study. (Echeverria-Villalobos et al, 2022).…”