From the Guidelines
NSAIDs reduce postoperative nausea and vomiting (PONV) by approximately 30-40%, with the most recent and highest quality study suggesting a multimodal approach to PONV management is most effective 1. This reduction is achieved through their anti-inflammatory properties and opioid-sparing effects. Common NSAIDs used for this purpose include:
- ketorolac (30mg IV or 15-30mg IM)
- ibuprofen (400-800mg orally)
- diclofenac (50-75mg orally or IM) These medications work by inhibiting cyclooxygenase enzymes, reducing prostaglandin synthesis which contributes to inflammation and pain. By providing effective pain control, NSAIDs decrease the need for opioid analgesics, which are known to cause nausea and vomiting. For maximum benefit, NSAIDs should be administered preoperatively or early in the perioperative period as part of a multimodal pain management and PONV prevention strategy, which may include other antiemetic agents such as dexamethasone and ondansetron 1. However, they should be used cautiously in patients with renal impairment, bleeding disorders, or gastric ulcers. The PONV-reducing effect of NSAIDs represents an important secondary benefit beyond their primary analgesic role in perioperative care. Key factors to consider when evaluating the risk of PONV include patient characteristics, such as female gender, non-smoker status, and history of motion sickness, as well as surgical and anesthetic factors, such as the use of volatile anesthetic agents and opioids 1. A multimodal approach to PONV management, including the use of NSAIDs and other antiemetic agents, can help to reduce the incidence of PONV and improve patient outcomes 1.
From the Research
Postoperative Nausea and Vomiting (PONV) Reduction by Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- The exact percentage reduction of PONV by NSAIDs is not directly stated in the provided studies.
- However, a study 2 compared the efficacy of three PCA regimens, including one with the NSAID ketorolac, and found that postoperative nausea and vomiting was significantly lower in groups receiving ketorolac.
- Another study 3 found that NSAIDs may reduce the incidence rates or severities of postoperative nausea, vomiting, or both compared to other analgesics, with a risk ratio of 0.18 (95% CI 0.06 to 0.57).
- The study 3 also found that NSAIDs may reduce pain intensity and opioid use within 24 hours of surgery, which can contribute to a reduction in PONV.
- A study 4 discussed the clinical significance and prevention of PONV, but did not provide specific information on the percentage reduction of PONV by NSAIDs.
Key Findings
- NSAIDs may reduce postoperative nausea and vomiting, pain intensity, and opioid use 2, 3.
- The combination of NSAIDs with other antiemetic strategies may increase the effectiveness of PONV prevention 4.
- High-quality large-scale RCTs are required to determine the exact percentage reduction of PONV by NSAIDs 3.