Recent progress in postoperative nausea and vomiting after thyroidectomy

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Postoperative nausea and vomiting (PONV) is a common and distressing complication following thyroidectomy. Notably, vomiting can increase both the risk and severity of postoperative complications, including cervical hematoma formation, wound dehiscence, postoperative bleeding, increased pain, delayed recovery and, in severe cases, airway compromise. The pathophysiology of PONV is multifactorial, involving interactions among peripheral surgical stimulation, central emetic pathways, anesthetic-related mechanisms and individual patient susceptibility. The recognized risk factors include female sex, non-smoking status, a history of motion sickness or prior PONV and exposure to volatile anesthetics or opioid analgesics during surgery. Contemporary perioperative practice emphasizes evidence-based multimodal prophylactic strategies supported by current consensus guidelines and randomized controlled trials to reduce PONV, including total intravenous anesthesia (TIVA), opioid-sparing analgesic techniques and intraoperative administration of serotonin (5-HT3) receptor antagonists and corticosteroids. Comprehensive risk assessments and individualized antiemetic strategies are essential for effectively reducing the incidence of PONV and improving overall postoperative outcomes in patients undergoing thyroidectomy. This narrative review summarizes recent progress in the epidemiology, mechanisms, risk assessment, prevention and treatment of PONV following thyroidectomy, with particular emphasis on thyroidectomy-specific factors and clinically applicable perioperative strategies. A better understanding of the underlying mechanisms may facilitate individualized risk stratification and optimize patient-centered perioperative care, ultimately improving postoperative outcomes in thyroidectomy patients.

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