Postoperative Nausea and Vomiting in Gynaecological Laparoscopic Surgeries: Risk Factors and Prevention Strategies

Background: Postoperative nausea and vomiting (PONV) remain among the most common and distressing complications following anaesthesia, particularly in gynaecological laparoscopic procedures. These surgeries inherently involve patient-, surgical-, and anaesthetic-related risk factors that synergistically increase PONV incidence. Objective: To review current evidence on risk factors for PONV in gynaecological laparoscopic surgery and outline prevention strategies based on contemporary guidelines. Methods: Literature from PubMed, Scopus, and Cochrane databases (2000?2025) was reviewed, focusing on prospective trials, meta-analyses, and international consensus guidelines. Results: Female sex, non-smoking status, history of PONV or motion sickness, and perioperative opioid use are key patient-related predictors. Laparoscopic techniques increase risk through pneumoperitoneum-induced diaphragmatic irritation and increased intra-abdominal pressure. Anaesthetic factors such as volatile agents, nitrous oxide, and prolonged surgery further compound risk. Prevention strategies include risk stratification (e.g., Apfel score), minimisation of baseline risks (opioid-sparing, total intravenous anaesthesia [TIVA]), and multimodal antiemetic prophylaxis using agents from different pharmacological classes (5-HT3 antagonists, dexamethasone, NK1 antagonists, dopamine antagonists). Non-pharmacological measures such as adequate hydration, low-pressure pneumoperitoneum, and regional anaesthesia techniques contribute to PONV reduction. Conclusion: Gynaecological laparoscopic surgery constitutes a high-risk setting for PONV. Risk-based multimodal prevention offers the most effective approach, aligning with recent consensus guidelines.