What causes nausea and vomiting post appendectomy (appendix removal)?

From the Guidelines

Nausea and vomiting after an appendectomy are primarily caused by anesthetic agents, opioid pain medications, and surgical manipulation of the bowels, and can be effectively managed with a multimodal approach including at least two antiemetic drugs, such as dexamethasone and ondansetron, as recommended by the most recent guidelines 1.

Causes of Nausea and Vomiting

The causes of nausea and vomiting post appendectomy can be multifactorial, including:

• Anesthetic agents used during surgery
• Opioid pain medications
• Surgical manipulation of the bowels
• Patient-related factors such as previous history of postoperative nausea and vomiting (PONV), female gender, younger age, non-smoker status 1

Management of Nausea and Vomiting

To manage nausea and vomiting after an appendectomy, I recommend:

• A multimodal approach using at least two antiemetic drugs, such as dexamethasone and ondansetron, as recommended by the most recent guidelines 1
• Starting with ondansetron (Zofran) 4mg IV or PO every 8 hours as needed, which blocks serotonin receptors in the chemoreceptor trigger zone
• Adding metoclopramide (Reglan) 10mg IV or PO every 6 hours for persistent symptoms, which enhances gastric emptying and may help if delayed gastric emptying is contributing to symptoms
• Using dexamethasone 4-8mg IV as a single dose, which provides longer-lasting antiemetic effects through its anti-inflammatory properties, but with caution in diabetics as it can worsen glycemic control 1
• Ensuring adequate hydration with IV fluids until oral intake improves, and starting with clear liquids before advancing to a regular diet as tolerated
• Minimizing opioid use by incorporating non-opioid analgesics like acetaminophen and NSAIDs (if not contraindicated) to reduce opioid-induced nausea
• Promoting early ambulation to enhance return of normal bowel function

Key Considerations

• Most patients experience improvement within 24-48 hours post-surgery, but persistent vomiting beyond this timeframe warrants further evaluation to rule out complications such as bowel obstruction or ileus
• The international consensus group on PONV recommends using 2 antiemetic drugs to decrease PONV and improve efficacy 1
• A risk assessment for PONV should be performed preoperatively, using scoring systems such as the Apfel score, to identify high-risk patients who may require more aggressive prophylaxis 1

From the FDA Drug Label

The provided drug labels do not directly address the causes of nausea and vomiting post appendectomy (appendix removal).

The FDA drug label does not answer the question.

From the Research

Causes of Nausea and Vomiting Post Appendectomy

• Nausea and vomiting post appendectomy (appendix removal) can be caused by various factors, including the use of general anesthesia, the surgical procedure itself, and postoperative care 2, 3, 4, 5, 6
• The use of propofol-based anesthesia can reduce the incidence of postoperative nausea and vomiting (PONV) after laparoscopic surgery, such as appendectomy 4
• Patient characteristics, such as age, sex, and medical history, can also influence the risk of PONV after appendectomy 4

Prevention and Treatment of PONV

• Prophylactic antiemetics, including 5-HT3 receptor antagonists (e.g., ondansetron, granisetron), can be effective in preventing PONV after appendectomy 2, 3, 4, 5, 6
• The combination of antiemetic therapy with a serotonin receptor antagonist (e.g., ondansetron, granisetron) and droperidol or dexamethasone can be highly effective in preventing PONV after laparoscopic surgery 4
• Non-pharmacologic techniques, such as acupressure at the P6 point, can also be effective in preventing PONV after laparoscopic surgery 4

Specific Studies on PONV

• A study published in 1994 found that ondansetron was effective in reducing nausea and vomiting after outpatient surgery under general anesthesia 2
• A study published in 2006 found that 5-HT3 receptor antagonists, including ondansetron and granisetron, were effective in preventing PONV after surgery 3
• A study published in 2011 found that the use of propofol-based anesthesia and prophylactic antiemetics, including ondansetron and granisetron, can reduce the incidence of PONV after laparoscopic cholecystectomy 4
• A study published in 2000 found that ondansetron was effective in reducing nausea and vomiting after ambulatory laparoscopic cholecystectomy 5
• A study published in 2014 found that ramosetron was more effective than ondansetron in preventing PONV after craniotomy 6