Mechanisms of reducing postoperative pain, nausea and vomiting: a systematic review of current techniques

Background Multimodal recovery programmes decrease hospital stay. The objective of this systematic review was to assess how single-modality evidence-based care principles, regarding postoperative analgesia and postoperative nausea and vomiting (PONV) prophylaxis, combine to achieve this. Methods A systematic review of randomised controlled trials was performed. Relevant trials compared postoperative epidural analgesia/parenteral opioid analgesia/paracetamol/non-steroidal anti-inflammatory drugs (NSAIDs) and postoperative antiemetics. The effect on recovery was evaluated in terms of length of hospital stay, pain intensity, duration of gastrointestinal dysfunction and incidence of PONV. Results Twenty-three trials were included. Epidural anaesthesia failed to reduce length of stay or the incidence of PONV when compared to controls. Pain intensity and time to first bowel movement were reduced (p