Nausea and vomiting can be issues after surgery. Why? Sometimes because of the anesthesia, sometimes because of the pain medication. If you are a cheap date (ie one glass of wine gets you tipsy) or get car sick easily, you are likely at higher risk for nausea following surgery.
There are general rules of thumb to reduce nausea. We use local anesthesia to decrease the amount of general anesthesia you get. Try to wean off narcotic pain medication as soon as you can to plain Tylenol. Celebrex is a NSAID which does not increase bleeding and is effective for some of my patients. Exparel is an injection I use for my tummy tucks which blocks the pain at the source- the muscle plication. Having food in your tummy before you take a bunch of pills helps. Fresh air/opening windows (especially on car rides) helps. But some people are just sensitive.
There are many medications we give for nausea. During your surgery with me, my anesthesiologist MDs usually give 4 different medications for nausea, and I include nausea medications in my prescribed medication
Nausea is no fun, but it also is tough on healing. When you are throwing up, you are straining your body, raising your blood pressure, not getting oral medications- like your pain medication or antibiotics, and not getting nutrition- which is super important to heal. So avoiding nausea is just good all around.
Common medications you see: Zofran, Phenergan, Reglan. Sometimes you will see people apply a Scopolamine patch prior to surgery.
So I was taking my American Board of Plastic Surgery update quiz, and one of the questions included a nausea medication I am not familiar with: Aprepitant. They indicated they thought it was more effective than the other medications I just mentioned. In their discussion, they state 40% of surgical patients get nausea, and those at “high risk” for nausea, the rate is 80%. They recommend attacking it with different medications. For every different medication you use, you reduce the risk of nausea by 25%.
Aprepitant is one to add to the mix. It is a highly selective medication that works at the brain level. (If you want to get nitty gritty, it is a neurokinin 1 receptor antagonist. It works well with other anti-nausea medications and seems to actually enhance those other medication effects.
So my thoughts? For those where Zofran doesn’t work, I have another tool in my toolbox. I love it. In general, when you can switch to non prescription pain medication (ie Tylenol) it is good to do so.