To the Editor:—

The recent article by Greif et al. , 1highlighted in The New York Times  Science section on November 9, 1999, published a reduction in postoperative nausea and vomiting (PONV) rate from 30% to 17% using supplemental postoperative oxygen. Although this would appear to be an impressive improvement, both of these rates fall well within the 15–40% PONV rate usually cited for this problem. The anesthetic regimen included the routine use of opioids in the form of 1–3 μg/kg fentanyl during induction, and more for maintenance.

Macario et al.  2confirmed the primacy in patients’ perspectives of the avoidance of PONV. Tang et al.  3recently published an article regarding the superiority of nonopioid analgesia using local anesthesia instead of opioids for reducing PONV and for greater patient satisfaction. Ponnudurai et al.  4recently published an article regarding the superiority of ketamine plus local anesthesia versus  alfentanil for pain relief and for ambulation.

Any study about PONV that includes the routine use of opioids may be trying to get the right answer by asking the wrong question. Avoiding the routine use of opioids, Friedberg 5,6recently published a 0.6% PONV rate in a series of 1,264 patients, one third of whom had PONV with the use of previous opioid-based anesthetics. Was Pogo right after all? Have we met the enemy, and is it us?

Greif R, Laciny S, Rapf B, Hinkle RS, Sessler DI: Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. A nesthesiology 1999; 91:1246–52
Macario A, Weinger M, Carney S, Kim A: Which clinical outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89:652–8
Tang J, Chen L, White PF, Watcha MF, Wender RH, Naruse R, Karinger R, Sloninsky A: Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast track office-based anesthesia. A nesthesiology 1999; 91:253–61
Ponnudurai R, Yu CW, Reyes A, Wu WH: A comparison of the preemptive effect of ketamine and alfentanil on the postoperative pain in patients undergoing abdominal hysterectomy while under general anesthesia. Am J Anesthesiol 1999; 26:381–4
Friedberg BL: Another perspective on PONV (letter). Anesth Analg 1999; 89:1589
Friedberg BL: Propofol-ketamine technique, dissociative anesthesia for office surgery: A five year review of 1,264 cases. Anesth Plast Surg 1999; 23:70–5