Talk:Postoperative nausea and vomiting

Meridian point

In conjunction with antiemetic medications, acupressure application to the Pericardium Meridian 6 point has been found to produce a positive effect, in relieving postoperative nausea and vomiting. However, any Pericardium Meridian 6 point device application needs to be patient-friendly, in its use during the perioperative period. Since over 60% of surgical procedures in the U.S. are performed in ambulatory settings, same day surgery patients could also benefit from the Pericardium Meridian 6 point acupressure technique.

The text above lacked a reference, so I did a Google search. The 2nd hit was this [1], which states:

RESULTS: Results showed that the incidence of postoperative nausea and vomiting was 36% in the treatment group and 40% in placebo group, which is statistically insignificant. CONCLUSION: Application of acupressure at P6 point half an hour before induction of anaesthesia does not significantly alter the incidence of postoperative nausea and/or vomiting within 6 hours after surgery.

I also found a reference to a study showing positive results. Therefore, I have edited the page to include both references.

I did not make an attempt to resolve the formatting difference between my citations and the citations already on the page, which did not appear to use the ref tag. —Preceding unsigned comment added by Loraan (talk • contribs) 20:47, 18 February 2009 (UTC)

Mechanisms

Mechanisms are missing from the article, described very well here: [2] --WS (talk) 11:58, 22 June 2013 (UTC)

Wiki Education assignment: Pathophysiology of Disease

This article was the subject of a Wiki Education Foundation-supported course assignment, between 16 December 2024 and 30 April 2025. Further details are available on the course page. Student editor(s): Ketadex (article contribs). Peer reviewers: Ccc1776, Pupsandplants.

— Assignment last updated by DataDrivenEllie (talk) 02:50, 6 May 2025 (UTC)

Hi, I think this is a good article to edit!

-The introduction is clear and concise.

-A few sections could be simplified to layman's terms a bit more, such as the "Cause" section and the "Prevention" section.

-The study at the beginning of "Risk Factors" is not clearly explained. I think expanding on the important aspects of that study may help make that reference a bit clearer.

-Another suggestion for the "Risk Factors" section, try using bullet points to clean up the formatting a bit. I think that small change might help!

-"PONV results from patient, surgical, and anesthetic factors." This sentence is unclear, under "Risk Factors".

-I think the "Epidemiology" section is a great section to have in there! Pupsandplants (talk) 17:47, 6 April 2025 (UTC)

Hi!

Thank so much for your input. It means a ton for you to take time out of your day to help improve this page :)

As suggested, I have tried to change some of the language to layman's terms. Format wise, I moved a few things around and used bullet points for the Apfel risk score to clean up the appearance, but do you think it is a good idea to use bullets for the paragraph above it as well? I would love to hear your thoughts on the subject.

I too enjoy the "Epidemiology" section, but I think the content it presents overlaps too much with the introductory paragraph. For the time being, I decided to combine the content of the two into the introduction while I comb through the literature for content that will do the "Epidemiology" section proper justice (if that makes sense) Ketadex (talk) 01:57, 14 April 2025 (UTC)

Ketadex Double check as I am not an expert of writing 'leads' (that is what we call the intro's on here), but the lead is supposed to be redundent- it is supposed to summarize the whole article so info should be repeated, and in more detail, in the subheadings below, along with the high quality secondary sources. Good luck!JenOttawa (talk) 18:12, 14 April 2025 (UTC)

Suggested structural and content edits

Intro

• Update statistics (Previously only covered risk)
• May combine content from last section titled "Epidemiology" into the introductory paragraph and delete the heading as a good portion of the information is redundant
  • Possibly change to: "PONV can be highly distressing for patients and may contribute reduced oral intake of fluids, food, and postoperative medications immediately following surgery, surgical complications, unanticipated overnight admission (~1% of all same day surgery patients), and delayed discharge."

Did this come from a source? Is it shared further down in the article? Keep in mind that the lead should be written in clear language for someone without a medical background to understand. Cheack out WP:MEDMOS for ideas on how these are written JenOttawa (talk) 17:49, 14 April 2025 (UTC)

Hi Jen! Thanks so much for the input.

The numbers discussed in this sentence are primarily from a previous contributor. Given my unfamiliarity with the source, I will move this part back down to the "Epidemiology" section and clean up some of the words to make it more digestible for the average reader. Let me know what you think about the new lead. Ketadex (talk) 19:40, 14 April 2025 (UTC)

Unfortunately I will not have time to return and review the edits right away. My advice is that if you follow the main guidelines including MEDMOS, WPMEDRS (most important), and paraphrase (original words, no direct quotes), keeping in mind that writing for Wikipedia is very different than we were trained to write in academia, your contribution will give the community a base to build off. The article will likely be tweaked by others as well, so just do your best and as long as the evidence is high quality (and neutral) it will be better than before! Good luck and hope you enjoy editing! Hopefully after your course you can come back later to help us continue to improve med articles in the future. It is great to have a strong community of editors on here.JenOttawa (talk) 19:53, 14 April 2025 (UTC)

• Clean up definitions/wording to make it flow better

usually on Wikipedia we try to use person-first terminology and reduce the use of "patient". For example, a person with a health condition or a person requiring surgery vs a surgery patient.JenOttawa (talk) 17:48, 14 April 2025 (UTC)

Cause/Risk Factors

• Will break down risk factors into section (Patient-related, surgical, and anesthesic-related)
  • Patient factors:
    • Clean up some of the wording and transition into already included information on genetic disposition towards PONV (Japan study)

Review WP:MEDRS and ensure that only high quality secondary sources are used to support paraphrased content added. If this study conducted in Japan has been reviewed in a systematic review, text book, the conclusions are in clinical guideline recommendations for identifying risk factors for this condition then use that source and not the original study published by a group in Japan. JenOttawa (talk) 17:53, 14 April 2025 (UTC)

• • Surgical:
  • Anesthetic-Related:
    • Clean up some of the wording to make existing and new content more cohesive
    • Adding non-volatile techniques with statistics like TIVA/Regional: "A significant body of evidence indicates that total intravenous anesthesia (TIVA) using propofol for induction and maintenance can reduce the incidence of PONV 3.5-fold in adults and 5.7-fold in children in comparison to volatile-anesthetic based techniques. Regional anesthesia has also demonstrated better outcomes for patients when compared to its general counterpart."

be sure to paraphrase evidence and include source - ensuring it is a high quality secondary source or this information should not be included in the article.JenOttawa (talk) 18:06, 14 April 2025 (UTC)

Hi Jen! Thanks again for your input!

Like above, the Japan study was added by the previous contributor. Given this is my first time editing an article, I was unsure of whether I can just delete/edit someone's work without running it past the talk page first. I can look a bit deeper into the source to see if it fits the criteria you listed.

Under the "Anesthetic-Related" section, I added two secondary sources for this part and tried paraphrasing to a degree, but do you mind giving it a look? I would love to hear what suggestions you have so I can drive this point home. Thanks! Ketadex (talk) 19:48, 14 April 2025 (UTC)

Mechanism

• Create a Mechanism heading to cover pathophysiology and incorporate writing from previous contributors while touching on the impact of surgical manipulation of neural circuits and their effect on PONV
• Something like: "Pharmacologic stimulation of different chemoreceptors in the brain trigger different pathways that can result in PONV. Additionally, direct surgical manipulation of the vestibular system (cranial nerve VIII) or gastrointestinal structures innervated by the vagus nerve (cranial nerve X) can further activate the neural pathways involved in precipitating nausea and vomiting." Might be a good idea to move the anesthestic-related mechanism above to this section. Thoughts?
• Still in its infancy so feel free to add/elaborate as needed :)

Prevention Strategies

• Adding "According to the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, key strategies in the prevention of PONV include diligent risk assessment and stratification, use of non-volatile anesthetic techniques when feasible, provision of prophylaxis based on risk, and employment of multimodal, opioid-sparing techniques for perioperative pain control." May have summarized the last part a bit incorrectly. Should say multimodal anti-emetic therapy AND opioid-sparing techniques for perioperative pain control in order to be more accurate.
• Clean up hydration section left by previous contributor

Ensure that this can make sense to a person who is not a doctor/healthcare professional or medical trainee. This looks like a secondary source. We usually do not need to share the source of the recommendations we are paraphrasing in the text unless it is really helpful for the reader to know this context and/or there are different views from medical bodies/differing results from high quality studies or systematic reviews. If there are not differing viewpoints, we usually would just write "Key strategies for preventing postoperative nausea and vomiting include.... (add secondary source- this one looks terrific, especially if published in the past 5 yrs- nice find)JenOttawa (talk) 17:59, 14 April 2025 (UTC)

Just also noting in my opinion, I would not use the PONV acronym as it is not a super common one and, in my opinion, makes it harder to read the article, especially for a person not in a medical field. Hope these tips are helpful! Thanks for helping to improve this articleJenOttawa (talk) 17:59, 14 April 2025 (UTC)

Very helpful, Jen! Thank you. Made a few edits. Let me know what you think. The Torbay Hospital section was from a previous contributor as well. Currently looking into the source. Ketadex (talk) 19:54, 14 April 2025 (UTC)

Management

• Incredible section created by previous contributors outlining medications involved in therapy. Great work!
• Will add a small introduction to the section that ties back to the "Mechanism" heading while also outlining alternative therapies that have been found to help with PONV.
  • Will keep medication section + Weibel Cochrane review mostly untouched, but will verify information
• Added additional alternative therapies and cleaned up pre-existing entry to flow better.
  • "A Cochrane systematic review and meta-analysis performed in 2022 suggests that music interventions in the perioperative period can effectively reduce postoperative vomiting, although their impact on nausea remains inconclusive. Another systematic review has shown that ginger consumption is associated with a significantly reduced incidence on PONV 6 hours after surgery when compared to placebo. However, further investigation evaluating ginger's efficacy against and with conventional anti-emetic prophylaxis is required to properly determine its use as a supplemental therapy."

Same comment here. Since you will be citing this secondary source, you do not need to write "A Cochrane systematic review published in 2022..." you can just share the evidence and cite the Cochrane Review. eg: There is some evidence supporting the effectiveness of music interventions for helping to prevent post-operative vomiting.(Cite review) The effectiveness on music therapy or musical interventions on post-operative nausea is not clear. Consuming ginger (<<<read paper to see is this supplements, candy, any ginger, tea etc>>>) may also... (ref) It is not clear if... These are just ideas. Looking forward to your improvements on this article :) JenOttawa (talk) 18:03, 14 April 2025 (UTC)

Hi Jen! Makes perfect sense.

I moved a few things around and cleaned up the wording to better align with the suggestions you made. Let me know what you think :) Ketadex (talk) 20:04, 14 April 2025 (UTC)

Epidemiology

• Possibly incorporate this information into the introduction and remove entirely as the information is pretty redundant? Will leave it up to y'all :)

Ketadex (talk) 18:04, 13 April 2025 (UTC)

@Ketadex: great to have your class here improving articles that so many people access! I included some ideas for improvements above.JenOttawa (talk) 18:08, 14 April 2025 (UTC)

Peer Review

Hello, I wanted to let you know that I have added my peer review. Great work! Ccc1776 (talk) 17:45, 14 April 2025 (UTC)