title: Management of postdischarge nausea and vomiting after ambulatory surgery.
abstract: OBJECTIVE
  Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24  h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identification and management is necessary for improving outcomes and helping patients after discharge. This review will discuss possible PDNV specific risk factors, successful prevention and management of PDNV following ambulatory anesthesia and the principles and pharmacology of these interventions.
  
  
  RESULTS
  Current research has demonstrated beneficial PDNV management up to 72  h with the long-acting 5-hydroxytryptamine-3 receptor antagonist palonosetron. Neurokinin-1 antagonists have demonstrated superior antiemesis, but not antinausea compared with more traditional and less expensive options. Dexamethasone provides improvements in quality of recovery associated with improved PDNV outcomes.
  
  
  CONCLUSIONS
  Further PDNV specific research is needed, including PDNV predictive models in directing antiemetic interventions. Long-acting antiemetics and postdischarge oral antiemetics are effective in PDNV pharmacologic management. Neurokinin-1 receptor antagonists are effective in reducing the incidence of vomiting, but not nausea. The addition of nonpharmacologic interventions such as acustimulation may reduce PDNV. Multimodal analgesia including nonopioid analgesics and ambulatory continuous peripheral nerve blocks are encouraged to achieve adequate postoperative analgesia and reduce opioid induced PDNV.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: M Stephen
authors.initials: MS
authors.lastname: Melton
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Klein
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: D000556:Ambulatory Surgical Procedures; D000758:Anesthesia / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D064729:Neurokinin-1 Receptor Antagonists; D000077924:Palonosetron; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy* / Q000517:prevention & control; D011812:Quinuclidines / Q000627:therapeutic use; D012307:Risk Factors; D012702:Serotonin Antagonists / Q000627:therapeutic use
chemical_list: D000932:Antiemetics; D018680:Cholinergic Antagonists; D005938:Glucocorticoids; D007546:Isoquinolines; D064729:Neurokinin-1 Receptor Antagonists; D011812:Quinuclidines; D012702:Serotonin Antagonists; D000077924:Palonosetron; D003907:Dexamethasone