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Section 1:
Feeling sick
Risks associated with your anaesthetic Section 1: Feeling sick
This leaflet explains the causes of sickness following anaesthesia and
surgery, what can be done to prevent it occurring, and treatments available
if it does happen to you.
Some words explained
operation, but it depends very much on Nausea. This is an unpleasant sensation,
who you are (see below), and on what usually in the stomach, also described as operation and anaesthetic you are having. ‘feeling queasy' or ‘feeling sick'. It is often These are explained here.
felt with the urge to vomit.
Why do some people feel sick after
Vomiting. This means being sick. It
is the act of forcefully emptying the There are a number of factors that we stomach, or ‘throwing up'.
know affect how likely you are to feel sick PONV. These letters are used to mean
after an operation. post-operative nausea and vomiting. ‘Post- The operation you are having
operative' means that it happens after the operation.
Some operations cause more sickness than others, for example: Anti-emetic drugs. These are medicines 4 operations in the abdomen or genital
that help to prevent or treat nausea and 4 ear, nose or throat operations (e.g. General anaesthesia. This is a state of
removal of tonsils) controlled unconsciousness during which 4 surgery to correct a squint of the eye you feel nothing and may be described as 4 very long operations.2 Your anaesthetist will be able to tell you Regional anaesthesia. This involves
if your operation is likely to cause post- an injection of local anaesthetic which operative nausea and vomiting.
makes part of your body numb. You stay Drugs that are used
conscious, but free from pain.
Some drugs are known to cause sickness: You can find out more about general 4 anaesthetic drugs, including some and regional anaesthesia in the booklet anaesthetic gases ‘Anaesthesia Explained', which is on the 4 pain relief drugs (especially the Royal College of Anaesthetists website morphine-like pain relieving medicines, including codeine).1,2 Will I feel sick after my operation?
Who you are
Not everyone feels sick after an operation Some people are more likely to suffer or anaesthetic, although it is a very from post-operative sickness: common problem. Overall, about one third of people (1 in 3) will experience a feeling of sickness after having an 1 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists

Section 1:
Feeling sick
4 those who suffer from ‘travel sickness' the pain of your operation feel worse, 4 anyone who has suffered from post- particularly if you are retching or vomiting, operative sickness before.2,4,5 and it can delay when you start eating and drinking after your operation. This may keep you in hospital longer.
4 Being without food or drink before and after the operation.
Rarely, if vomiting is severe and lasts a long 4 Being very anxious about what is time, it can result in other more serious happening can make you more problems, such as damage to your operation likely to feel sick. You can tell your site, tears to your oesophagus (gullet), or anaesthetist that you are feeling damage to your lungs.1 anxious. He/she will talk to you about your worries and you can ask for a Can anything be done to prevent
medicine to help you with this.2 me from feeling sick after my
4 Travelling shortly after receiving a general anaesthetic. If you are going home the same day, you may find Yes, although the risk of sickness that you feel sick or vomit during the can never totally be removed. Your journey. You are more sensitive to anaesthetist will assess your risk of travel sickness during this time.
experiencing sickness when they visit you before your operation.
I felt sick after my last operation.
Will I feel sick after this operation?
There are various ways in which your Not necessarily.
anaesthetist can change your anaesthetic in order to reduce your chance of 4 Your operation may be different and suffering sickness.
less likely to cause sickness.
4 Your anaesthetic can be tailored to You may be able to have your reduce the likelihood of a recurrence.
operation performed under a regional anaesthetic rather than general 4 You may now be less likely to suffer anaesthetic, as this may reduce the (for example, the possibility of sickness that you feel.2–5 experiencing sickness after surgery lessens as you grow older).2 4 You may be given one or several But if you have had sickness after surgery ‘anti-sickness' medicines, called anti- previously, you are more likely to have it emetics, as part of your anaesthetic.1–5 again than if you have had an anaesthetic 4 Some anaesthetic drugs are less likely previously without any sickness.
to cause sickness than others. Your anaesthetist may decide that you are How long does the feeling of
suitable to receive them.1–5 4 Acupuncture or acupressure can be Usually the sensation of sickness is used to prevent or treat sickness after short-lived or stops following treatment. surgery, but not all hospitals are able Uncommonly, it can be prolonged and last to provide this treatment.6 for more than a day.
4 You may receive intra-venous fluids via a cannula (fluid goes into a thin Can feeling sick after an operation
plastic tube placed in a vein – often called a ‘drip'). This may be given for Feeling sick or vomiting after an operation is other reasons, but has been shown to distressing and unpleasant. It can make help prevent sickness.3–5 2 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists

Section 1:
Feeling sick
If you are worried about sickness, or 4 Ondansetron (Zofran) or granisetron
have experienced it following a previous (Kytril) or tropisetron (Navoban).
operation, it is important that you inform Can cause headaches (uncommon).
your anaesthetist.
4 Dexamethasone. Although a steroid
Is there any treatment available if I
drug, the single dose given to prevent feel sick after my operation?
nausea and vomiting does not seem to be associated with the side effects seen Yes. If you feel sick after your operation, with long-term steroid use.
the methods used to prevent you feeling 4 Prochlorperazine (Stemetil).
sick can also be used to treat it. For May cause tremors or uncontrolled example you could be given anti-emetic body movements, known as an (anti-sickness) drugs and intra-venous extrapyramidal reaction (rare) 4 Scopolamine (Scopoderm). Can
It is much easier to relieve the feeling of be given as a sticky patch 5–6 hours sickness if it is dealt with before it gets too before your operation, to give it time bad. So, you should ask for help as soon to work. It can cause blurred vision as you feel sick.
and a dry mouth (uncommon).
Can I do anything to avoid feeling
What drugs may I be given and do
they have side effects?
Yes. After your surgery: Anti-emetic drugs can be given as a tablet 4 avoid sitting up or getting out of bed or as an injection. Injections can be given intra-venously into your cannula or into your leg or buttock muscle. Intra-venous 4 avoid drinking and eating immediately injections work more quickly and reliably after your operation. Start with small sips of water and slowly build up to and avoid the need for another needle.
bigger drinks and light meals. Your The same drugs are used to prevent and nurse will give you advice about this treat sickness after surgery. There are 4 good pain relief is important. several different types. A combination of Although some pain relieving anti-emetic drugs may be given, as this is medicines can make you feel sick, more effective than one drug given on its severe pain will too. You should ask for help if you are not sure All medicines have some side effects, 4 taking slow deep breaths can help to although with anti-emetics these are reduce any feeling of sickness.
generally minor and temporary, or rare. Where can I get further information?
The following are commonly used anti- If you want to ask any further questions emetic drugs.
about the type of anaesthetic planned for 4 Cyclizine (Valoid). May cause
your operation please contact your local drowsiness and a dry mouth hospital or clinic before you come into 3 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists

Section 1:
Feeling sick
Dr Ian Selby, FRCA
1 Apfel CC et al. IMPACT Investigators. A factorial
Consultant Anaesthetist
trial of six interventions for the prevention of Hull Royal Infirmary
postoperative nausea and vomiting. N Engl J Med
2004;350:2441–2451.
2 Gan TJ. Risk factors for postoperative nausea and
vomiting. Anesth Analg 2006;102:1884–1898.
Dr Tim Smith, MD FRCA
3 Harmer M. Pharmacological intervention in post-
Consultant Anaesthetist
operative nausea and vomiting: scientific evidence Alexandra Hospital, Redditch
and expert opinion for anti-emetic therapy for Final FRCA examiner
prophylaxis. In: Strunin L, Rowbotham DJ, Miles A (Eds). The effective management of post-operative nausea and vomiting, 2nd edition. Aesculapius Medical Press, London 2003; pp 53–70.
4 Gan TJ et al. Consensus guidelines for managing
postoperative nausea and vomiting. Anesth Analg
2003;97:62–71.
5 Gan TJ et al. Society for Ambulatory Anesthesia
guidelines for the management of postoperative
nausea and vomiting. Anesth Analg 2007;105:1615–
1628.
6 Apfel CC et al. Acustimulation of P6: an antiemetic
alternative with no risk of drug-induced side-efects.
Br J Anaesth 2009;102:585-586.
The Royal College of Anaesthetists
Revised edition 2009 The material from this article may be copied for the purpose of producing information materials for patients. Please quote the RCoA as the source of the information. If you wish to use part of the article in another publication, suitable acknowledgement must be given and the RCoA logo must be removed. For more information or enquiries about the use of this leaflet please contact: The Royal College of Anaesthetists
website: www.rcoa.ac.uk
email: [email protected]
The Royal College This leaflet will be reviewed three years from the date of publication.
4 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists

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