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Non-Pharmacological Options 


P6 Acupuncture Stimulation 


  • Efficacy = prophylactic antiemetics such as ondansetron, droperidol, metoclopramide

  • Timing of trans-cutaneous acupoint electrical stimulation does not impact PONV, with similar reductions being achieved with stimulation initiated before or after induction of anesthesia

  • Neuromuscular stimulation over the median nerve also reduces the incidence of PONV in the early postoperative period, particularly when tetanic stimulation is used  

  • Stimulation of L14 and ST36 acupoints may also be effective


Adequate IV Hydration 


  • 10-30 ml/kg effective to reduce risk of PONV

  • No difference between crystalloid vs colloids


Carbohydrate loading

  • Inconsistent results but overall no impact on PONV


  • Reduced need for rescue antiemetics (low evidence) but not incidence or severity of nausea

  • Isopropyl alcohol somewhat effective; peppermint not effective


Chewing gum

  • Early evidence that might be helpful



Adapted from Anesth Analg. August 2020 - Volume 131 - Issue 2 - p 411-448

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