Causes and prevention strategies of postoperative nausea and vomiting after orthognathic surgery

doi:10.7518/hxkq.2025.2025072

Abstract

Abstract:

Postoperative nausea and vomiting (PONV) are common complications that mainly occur within 24 h after orthognathic surgery. The incidence of nausea and vomiting after orthognathic surgery remains high and is a difficult problem for patients and surgeons. These complications not only affect wound healing and increase the risk of postoperative bleeding. Vomit and blood may also cause nausea and vomiting, which results in a vicious cycle. Frequent nausea and vomiting are a painful experience and more serious than postoperative pain. They are one of the main reasons for postoperative infection, delayed discharge, and increased hospitalization costs and affect patient satisfaction. In this review, the author combined literature review and clinical experience and summarized and analyzed the causes of orthognathic nausea and vomiting and prevention and treatment strategies to improving the related clinical process.

Key words: orthognathic surgery, nausea, vomit, prevention, treatment

CLC Number:

R782.05

Luo Kai, Liu Le, Zhao Le, Tang Yanglu, Luo En, Ji Yang. Causes and prevention strategies of postoperative nausea and vomiting after orthognathic surgery[J]. West China Journal of Stomatology, 2025, 43(3): 305-313.

Figures/Tables 2

References 44

1	Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting[J]. Br J Anaesth, 2012, 109(5): 742-753.
2	Silva AC, O’Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review[J]. J Oral Maxillofac Surg, 2006, 64(9): 1385-1397.
3	Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131(2): 411-448.
4	Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting[J]. Br J Anaesth, 1992, 69(7 ): 24S-32S.
5	Ghosh S, Rai KK, Shivakumar HR, et al. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study[J]. J Korean Assoc Oral Maxillofac Surg, 2020, 46(2): 116-124.
6	Phillips C, Brookes CD, Rich J, et al. Postoperative nausea and vomiting following orthognathic surgery[J]. Int J Oral Maxillofac Surg, 2015, 44(6): 745-751.
7	Beattie WS, Lindblad T, Buckley DN, et al. The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle[J]. Can J Anaesth, 1991, 38(3): 298-302.
8	Koivuranta M, Läärä E, Snåre L, et al. A survey of postoperative nausea and vomiting[J]. Anaesthesia, 1997, 52(5): 443-449.
9	Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting[J]. N Engl J Med, 2004, 350(24): 2441-2451.
10	Parker RM, Bentley KR, Barnes NM. Allosteric modulation of 5-HT3 receptors: focus on alcohols and anaesthetic agents[J]. Trends Pharmacol Sci, 1996, 17(3): 95-99.
11	Eger EI 2nd, Raines DE, Shafer SL, et al. Is a new paradigm needed to explain how inhaled anesthetics produce immobility[J]. Anesth Analg, 2008, 107(3): 832-848.
12	Divatia JV, Vaidya JS, Badwe RA, et al. Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting. A meta-analysis[J]. Anesthesiology, 1996, 85(5): 1055-1062.
13	Shetty V, BhanuPrakash B, Yadav A, et al. Do regional nerve blocks before bimaxillary surgery reduce postope-rative pain[J]. J Oral Maxillofac Surg, 2020, 78(5): 724-730.
14	Chen YA, Rivera-Serrano CM, Chen C, et al. Pre-surgical regional blocks in orthognathic surgery: prospective study evaluating their influence on the intraoperative use of anaesthetics and blood pressure control[J]. Int J Oral Maxillofac Surg, 2016, 45(6): 783-786.
15	Wang X, Feng Y, Yang X, et al. Preoperative ultrasound-guided trigeminal nerve block in orthognathic surgery: a prospective study about its efficacy of intraoperative anesthetic dosage and postoperative analgesia[J]. J Oral Maxillofac Surg, 2021, 79(10): 2042-2050.
16	吴宇飞, 王沛娟, 刘冰, 等. 神经阻滞技术在正颌手术的应用进展[J]. 麻醉安全与质控, 2021, 5(6): 460-463.
	Wu YF, Wang PJ, Liu B, et al. Progress in the application of nerve block technique in orthognathic surgery[J]. Perioper Saf Qual Assur, 2021, 5(6): 460-463.
17	Ishikawa E, Iwamoto R, Hojo T, et al. Cross-sectional study of PONV risk factors for oral surgery after intubated general anesthesia with total intravenous anesthesia[J]. Anesth Prog, 2022, 69(1): 18-23.
18	Tishchenko AS, Dobrodeev AS. Practical potentials of using dexmedetomidine in oral and maxillofacial surgery[J]. Stomatologiia (Mosk), 2019, 98(6): 131-135.
19	Gao PF, Zhao L, Li SY, et al. Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review[J]. BMC anesthesiol, 2024, 24(1): 121.
20	Gan TJ, Meyer TA, Apfel CC, et al. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2007, 105(6): 1615-1628.
21	Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2014, 118(1): 85-113.
22	Kim SG, Park SS. Incidence of complications and problems related to orthognathic surgery[J]. J Oral Maxillofac Surg, 2007, 65(12): 2438-2444.
23	Aydil BA, Akbaş M, Ayhan M, et al. Retrospective examination of complications observed in orthognathic surgical surgery in 85 patients[J]. Ulus Travma Acil Cerrahi Derg, 2022, 28(5): 698-702.
24	Athanassoglou V, Patel A, McGuire B, et al. Systematic review of benefits or harms of routine anaesthetist-inserted throat packs in adults: practice recommendations for inserting and counting throat packs: an evidence-based consensus statement by the Difficult Airway Society (DAS), the British Association of Oral and Maxillofacial Surgery (BAOMS) and the British Association of Otorhinolaryngology, Head and Neck Surgery (ENT-UK)[J]. Anaesthesia, 2018, 73(5): 612-618.
25	Muhammad R, Wadood F, Haroon T, et al. Efficacy of gastric aspiration in reducing post-tonsillectomy vomi-ting in children[J]. J Ayub Med Coll Abbottabad, 2012, 24(3/4): 28-30.
26	Ng A, Smith G. Gastroesophageal reflux and aspira-tion of gastric contents in anesthetic practice[J]. Anesth Analg, 2001, 93(2): 494-513.
27	Beck CE, Rudolph D, Mahn C, et al. Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: results of the German prospective multicenter observational (NiKs) study[J]. Paediatr Anaesth, 2020, 30(8): 892-899.
28	Andersson H, Zarén B, Frykholm P. Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite[J]. Paediatr Anaesth, 2015, 25(8): 770-777.
29	Disma N, Frykholm P, Cook-Sather SD, et al. Pro-con debate: 1- vs 2-hour fast for clear liquids before anesthesia in children[J]. Anesth Analg, 2021, 133(3): 581-591.
30	Ahiskalioglu A, İnce İ, Aksoy M, et al. Effects of a single-dose of pre-emptive pregabalin on postoperative pain and opioid consumption after double-jaw surgery: a randomized controlled trial[J]. J Oral Maxillofac Surg, 2016, 74(1): 53.e1-7.
31	Labafchi A, Shooshtari Z, Grillo R, et al. The beneficial effect of preoperative dexmedetomidine in controlling postoperative pain, nausea, and vomiting after orthognathic surgery: a triple-blind randomized clinical trial[J]. J Oral Maxillofac Surg, 2023, 81(8): 941-949.
32	Chatellier A, Dugué AE, Caufourier C, et al. Inferior alveolar nerve block with ropivacaine: effect on nausea and vomiting after mandibular osteotomy[J]. Rev Stomatol Chir Maxillofac, 2012, 113(6): 417-422.
33	Vetter M, Chatellier A, Maltezeanu A, et al. The benefit of bilateral inferior alveolar nerve block in managing postoperative nausea and vomiting (PONV) after mandibular osteotomy[J]. J Craniomaxillofac Surg, 2020, 48(4): 399-404.
34	Wang LK, Cheng T, Yang XD, et al. Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial[J]. J Anesth, 2022, 36(1): 122-136.
35	Grant MC, Kim J, Page AJ, et al. The effect of intravenous midazolam on postoperative nausea and vomiting: a meta-analysis[J]. Anesth Analg, 2016, 122(3): 656-663.
36	Lee Y, Wang JJ, Yang YL, et al. Midazolam vs ondansetron for preventing postoperative nausea and vomiting: a randomised controlled trial[J]. Anaesthesia, 2007, 62(1): 18-22.
37	Powell K, Amin D, Sesanto R, et al. Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery[J]. Int J Oral Maxillofac Surg, 2022, 51(3): 366-370.
38	Faro TF, de Oliveira ESED, Campos GJ, et al. Effects of throat packs during orthognathic surgery: a double-blind randomized controlled clinical trial[J]. Int J Oral Maxillofac Surg, 2021, 50(3): 349-355.
39	Vural Ç, Yurttutan ME, Sancak KT, et al. Effect of ch-lorhexidine/benzydamine soaked pharyngeal packing on throat pain and postoperative nausea & vomiting in orthognathic surgery[J]. J Craniomaxillofac Surg, 2019, 47(12): 1861-1867.
40	De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, et al. Dexamethasone to prevent postoperative nausea and vo-miting: an updated meta-analysis of randomized controlled trials[J]. Anesth Analg, 2013, 116(1): 58-74.
41	Nuttall GA, Malone AM, Michels CA, et al. Does low-dose droperidol increase the risk of polymorphic ventricular tachycardia or death in the surgical patient[J]. Anesthesiol, 2013, 118(2): 382-386.
42	Wallenborn J, Gelbrich G, Bulst D, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial[J]. BMJ, 2006, 333(7563): 324.
43	Som A, Bhattacharjee S, Maitra S, et al. Combination of 5-HT3 antagonist and dexamethasone is superior to 5-HT3 antagonist alone for PONV prophylaxis after la-paroscopic surgeries: a meta-analysis[J]. Anesth Analg, 2016, 123(6): 1418-1426.
44	DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)[J]. BMJ, 2017, 357: j1455.

药物	预防给药时间	成人剂量/mg IV	小儿剂量（最大剂量）
昂丹司琼	手术结束前	4~8	0.05~0.15 mg IV（4 mg）
多拉司琼	手术结束前	12.5	0.35 mg/kg IV（12.5 mg）
托烷司琼	手术结束前	5	0.2 mg IV（5 mg）
格拉司琼	手术结束前	3	0.04 mg/kg IV（3 mg）
帕洛诺司琼	诱导前	0.075	-
地塞米松	诱导前	4~5	0.1~0.15 mg/kg IV（5 mg）
甲氧氯普胺	手术结束前	10~20	0.1 mg/kg IV（5 mg）
氟哌利多	手术结束前	0.625~1.25	0.01~0.015 mg/kg IV（1.25 mg）
氟哌啶醇	手术结束前	0.5~2	-

风险分层	预防性治疗	初次治疗	再次治疗
低风险	考虑	地塞米松或5-HT₃受体阻断剂	-
中风险	应该	地塞米松或5-HT₃受体阻断剂	6 h内避免重复用药，应予以不同种类的止吐药物；超过6 h且无其他药物可选时，则应再次予以5-HT₃受体阻断剂或多巴胺D2受体拮抗剂或丁酰苯类止吐药
高风险	必须	地塞米松和5-HT₃受体阻断剂，可加用多巴胺D2受体拮抗剂或丁酰苯类止吐药	同中风险

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