•  Reduction of risk (Anesth Analg 2007;105:1615–1628)

• Regional techniques (general anesthesia has 11-fold ↑ risk of PONV)

• Propofol (19% ↓ PONV risk compared to inhalational agents)

• Avoid nitrous oxide (12% ↓ PONV risk), inhaled anesthetics, neostigmine

• Minimize opioids

• Ensure adequate hydration

•  PONV rescue strategy

• If initial agent is ineffective → give drug from a different class

• Repeat droperidol and 5-HT3 antagonists q6h

• Repeat administration of dexamethasone not recommended

•  Discharge criteria

• Often based on formal scoring systems (see Chapter 13-6, PACU Management) or RN/MD assessment

• Oral intake: Not required prior to discharge

• Voiding: Only required if pt received neuraxial anesthesia or had gynecologic, hernial, anorectal, or genital surgery

• Spinal/epidural anesthesia: pt must have return of sensation & no motor block

• Nerve blocks: discharge can occur before full return of motor/sensory function, instruct pt to protect numb limb from injury

PAIN ISSUES FOR THE OUTPATIENT SETTING