MANAGEMENT OF POSTOPERATIVE NAUSEA AND VOMITING (PONV) WITHIN THE ENHANCED RECOVERY AFTER SURGERY (ERAS) CONCEPT AND INTRAOPERATIVE NAUSEA AND VOMITING (IONV)

Background: Postoperative Nausea and Vomiting (PONV) occurs as a common adverse event subsequent to surgery with rates reported to reach 30% in patients undergoing surgery generally, with occurrence rates approaching 80% in those considered high risk. This occurrence impacts patient satisfaction, prolongs length of stay, and increases the
risk of complications. PONV management under the Enhanced Recovery After Surgery (ERAS) framework includes risk factor identification, prevention strategies, multimodal prophylaxis administration, and therapeutic management based on different pharmacological classes. Intraoperative Nausea and Vomiting (IONV), particularly in cesarean section operations with regional anesthesia, has its own characteristics and risk factors, such as hypotension, peritoneal stretching, and uterotonic use.
Aim: This study reviews current evidence regarding pathophysiology, risk assessment systems, prevention strategies, and pharmacological and non-pharmacological therapeutic options for PONV and IONV, while discussing the application of these guidelines within the ERAS context.
Materials and Methods: A review was conducted to examine current evidence-based approaches for PONV and IONV management within the ERAS framework. Evidence from the Fourth Consensus Guidelines on PONV Management 2020, randomized controlled trials, meta-analyses, and case studies were synthesized to evaluate
multimodal prophylaxis strategies and therapeutic interventions.
Results: A case report of a patient with severe aortic stenosis undergoing elective cesarean section with low-dose spinal anesthesia technique demonstrates that applying ERAS principles, including postoperative chewing gum use, can maintain hemodynamic stability, minimize PONV/IONV, and accelerate recovery.
Conclusion: The multimodal approach integrated within ERAS proves effective in reducing PONV and IONV incidence, improving patient comfort, and accelerating discharge time.