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Archive November 2020 XXI, No. 11

PONV Prevention Pays Off

Aromatherapy, antiemetics and regional blocks improve discharge times and increase patient satisfaction scores.

Jennifer Amedio

Jennifer Amedio, RN, BSN, CCRN, PCCN, CPAN, CAPA


Jennifer Amedio
SWEET SMELL Aromatherapy inhalers offer a blend of four pure and natural essential oils, all of which are known to have therapeutic effects on nausea.

Postoperative nausea and vomiting is the last thing patients want to deal with when they're recovering from surgery. Waking up in the PACU feeling sick can ruin any good feelings they might have had about a successful procedure and the care your team provided. PONV can also lead to concerns more serious than satisfaction scores: prolonged post-op stays, unanticipated hospital admissions, wound dehiscence, aspiration, esophageal tears, electrolyte imbalance and an overall delay in a return to functional ability. Thankfully, there are several effective and economical ways to prevent PONV, especially if you're willing to think outside the box.

  • Nerve blocks and antiemetics. Narcotics can cause PONV because they slow bowel function, which can lead to constipation, bloating, vomiting and nausea. Employing regional anesthesia, which minimizes the use of heavy narcotics and volatile anesthetics, immediately eliminates two risk factors. As a result, patients will have shorter recoveries, experience less pain and have little to no nausea.

Anesthesia providers play an important role in preventing PONV, because they can employ regional blocks before surgery begins. They might also administer antiemetics — metoclopramide, cyclizine, prochlorperazine, droperidol, ondansetron or dexamethasone — prior to and during surgery, especially to patients who present with risk factors associated with PONV.

  • Aromatherapy. For many years, nurses would place an alcohol swab under the nose of a recovering patient who was nauseous in an effort to relieve the queasy feeling, but sweeter smelling options are now available. Aromatherapy's exact mechanism of action on the prevention of PONV is unknown, but it impacts the olfactory bulb, where impulses are processed and transmitted to the limbic system of the brain, and then to the central nervous system.

Before adding aromatherapy to our PONV-prevention protocols, we decided to test its effectiveness on more than 300 patients. When patients arrived in PACU, they were asked to rate their nausea from 0 to 10, with 10 being the worst. After three to five minutes of using aromatherapy inhalers, patients were asked to again rate their nausea. The average pre-intervention score was 6.11; the average post-intervention score was reduced to 2.82. We also found that 37% of patients who were treated with aromatherapy did not need any additional treatment. In fact, we also saw a significant reduction in the use of antiemetics prescribed because of aromatherapy. In three months, we were able to save 43 doses of promethazine and 34 doses of ondansetron.

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