This is an important finding, as it shows that the abolishment of postoperative nausea and vomiting is indeed within grasp utilizing the concept of multimodal therapy. Multimodal therapy suggests that attacking the problem of PONV from many different angles and through many different mechanisms is more succesful than just targeting one mechanism.

However, there are a number of issues that need to be addressed:

1. Is the protocol cost effective? Although costs are reduced as a result of earlier discharge home and less need for medication used to treat nausea - this must be compared to the significant cost of the protocol.

2. Does the protocol provide more benefit than risk? Anytime you give a medication to a patient, there is a risk of a side effect or reaction. The protocol proposed involves the administration of a number of medications to each patient - and some patients obviously would be asymptomatic even without the medications. Does the benefit outweigh the risk?

3. Are the results applicable for all cases? The study was done in patients undergoing laparoscopy. Does this imply that the protocol is effective in other types of surgery?

4. Which aspects of the protocol are the most important? Would it work if one element was eliminated? Is the effect we see mainly due to one specific part of the protocol?

It is nice to know that developments in our pharmaceuticals has enabled the virtual elimination of nausea and vomiting that we see in this study. In addition , the protocol highlights a number of different ways to attack the problem of nausea and vomiting. For the high-risk patient, I am sure that many will be motivated to try the protocol. However, the author of the study does not claim that the protocol should be standard therapy or that the results can be generalized - and a number of questions remain to be answered before this protocol can be considered routine treatment.

Reference:
Scuderi PE, et al. "Multimodal Antiemetic Management Precents Early Postoperative Vomiting after Outpatient Laparoscopy.: Anesth Analg 2000 Dec;91(6):1408-14.