Alternative Ways to Prevent PONV

Patient Experience

By: Mary Corley

Published: 5/15/2020

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All-natural therapies and products can lower the risk of the common complication all patients dread.


Post-operative nausea and vomiting is the last thing patients who've just had surgery need to deal with. Whether PONV is caused by anxiety, a bad reaction to anesthesia or both, it's easier to prevent than it is to treat. Common medications used to combat PONV, however, have side effects of their own. Thankfully, there are several simple and effective remedies you can use to stop that queasy feeling before it starts.

  • Mindful relaxation. Patients aren't always nauseous post-operatively because they're having a physical reaction to the anesthesia or are re-awakening to the anxiety they're feeling because of the surgery. Sometimes, their body is out of balance, and restoring that balance can assist with the healing process.

Reiki, a Japanese technique that involves massage-like touch therapy, not only reduces stress and induces relaxation, it also can promote healing. "Rei" means "universal" and "Ki" refers to a vital life-force energy. Reiki isn't hypnosis — the patient isn't relinquishing control to the practitioner. It's not the offspring of a religion; it's not dogmatic; it's not about mind control; and it's not placebo. If the patient is open to it, they're in control. It's a self-regulating, very democratic form of healing.

You don't have to explain all the details to a patient who's still a little groggy in PACU. I simply say, "If you're interested, there's a technique called Reiki that can help alleviate your symptoms. I'm going to try to alleviate your pain, and I'm going to try to help with your nausea."

Of course, Reiki, pre-op meditation and all alternative non-pharmaceutical therapies don't have to be used instead of narcotics for pain control and traditional antiemetic medications for PONV. They can be used in conjunction with them. In fact, it's generally not a good idea to use these methods as complete substitutes. While I certainly don't push pain-control medications on patients, I do inform those who are resistant to taking them that the medications will help manage their pain. Without traditional medications, pain increases, and nausea would only get worse.

  • Acupuncture and acupressure. These ancient Eastern medicines are evidence-based and less expensive alternatives to traditional antiemetics that are often ineffective or not appropriate for use with some patients. Worse, they can produce side effects that require additional drugs to manage, all on top of the anesthesia and pain medications that are already taxing patients' kidneys and livers.

The most common acupuncture point is the Pericardium 6 (PC6) near the wrist. Studies have shown that PC6 stimulation has comparable effects to traditional antiemetics — metoclopramide, cyclizine, prochlorperazine, droperidol, ondansetron and dexamethasone — in PONV prevention.

MIND OVER MATTER Reiki, meditation and mindfulness can be used as alternatives to standard antiemetic medications.

Acupressure also uses the PC6 acupoint, but is less invasive, as it uses firm pressure to massage the forearm near the wrist instead of acupuncture's stimulation of the acupoint with an extremely thin needle. Acupressure offers an additional advantage of being utilitarian. Almost any member of your staff can apply it, while a licensed acupuncturist is required for acupuncture.

Acupressure can even be taught to the patients and their family members. As with Reiki and meditation, these therapies are often used as supplements to traditional medications. They could, however, serve as replacements, depending on what's best for an individual patient.

When I use these therapies in my practice, I look at the whole person and create an individualized treatment plan. There might be some other aspect of their being that is grossly out of balance that could be relieved with pressure applied on another acupoint.

Many people come to my acupuncture practice with interest in optimizing the condition of their bodies before surgery and enhancing their recoveries afterward. Acupuncture can help them meet those goals.

  • Aromatherapy. Lavender, ginger, spearmint, peppermint and other essential oils have well established positive effects on nausea originating from the stomach Qi. Surgery can disrupt the body's natural balance and reverse the stomach's Qi, causing it to push things up and out instead of down and in. Aromatherapy can be used to settle the Qi to restore its natural function.

Stomach or intestinal issues aren't always the result of post-op nausea, however. PONV is a most often a reaction to general anesthesia, which is very toxic to the body. Further, patients are often very nervous on the day of surgery and therefore don't breathe evenly. On top of all of it, their livers and kidneys are already overloaded with toxic substances and pollutants that make it difficult for the body to rid anesthesia.

Many of these oils have multiple benefits. Lavender oil, in addition to being effective for nausea, can induce relaxation or help with headaches when applied to the bottom of the feet.

A quick-and-dirty tip is to simply have patients sniff an alcohol swab. That's very effective for PONV. Several alcohol-based aromatherapy products have been introduced in recent years, including patches that attach to patients' gowns, inhaler tubes, or self-adhesive strips that stick to patients' shirts.

Satisfying solutions

These simple-yet-effective natural alternative treatments can go a long way to preventing PONV by themselves or buoying traditional pharmaceutical treatments. They can minimize the extended patient stays in the PACU that aren't good for your facility's workflow and don't bode well for satisfaction scores that follow. Feeling sick after a procedure often sticks in patients' minds more than the professional care and positive clinical outcomes that preceded it. While PONV is out of your control, managing the condition effectively will ensure patients won't leave your facility with a bitter taste in their mouths. OSM

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