Opioid Free Anesthesia to Prevent Post Operative Nausea/Vomiting

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice. Methods In this scoping review, the MeSH search terms used to collect data were “anesthesia”, “postoperative nausea and vomiting”, “morbidity”, “retrospective studies”, “anesthesia, general”, “analgesics, opioid”, “pain postoperative”, “pain management” and “anesthesia, intravenous”. The Discovery Search engine, AccessMedicine and UpToDate were the search engines used to research this data. Filters were applied to these searches to ensure all the literature was peer-reviewed, full-text and preferably from academic journals. Results Opioid free anesthesia was found to decrease PONV by 69%. PONV incidence was overwhelming decreased with opioid free anesthesia in every study that was reviewed. Implications The future direction of opioid-free anesthesia and PONV prevention are broad topics to discuss, due to the nature of anesthesia. Administration of TIVA, esmolol and ketamine, as well as the decision to withhold opioids, are solely up to the anesthesia provider’s discretion. Increasing research and education in the importance of opioid-free anesthesia to decrease the incidence of PONV will be necessary to ensure anesthesia providers choose this protocol in their practice.