Which strategy directly reduces postoperative nausea and vomiting by minimizing opioid exposure?

• A. Risk assessment and prophylactic antiemetics
• B. Multimodal analgesia to reduce opioids
• C. Adequate hydration
• D. Consider regional anesthesia when appropriate

Answer: (B)

Reducing opioid exposure directly lowers the nausea and vomiting that opioids commonly provoke. Opioids trigger postoperative nausea and vomiting by activating the chemoreceptor trigger zone, slowing gastric motility, and affecting the vestibular system. Using multimodal analgesia means controlling pain with a mix of non-opioid medications and techniques (such as acetaminophen, NSAIDs, regional anesthesia or nerve blocks, local anesthetics, and certain adjuvants) so patients need fewer opioids after surgery. With less opioid intake, the emetogenic stimulus is reduced, and PONV risk drops as a direct effect.

Other strategies can help—prophylactic antiemetics manage symptoms, and ensuring good hydration supports overall recovery—but they don’t address the underlying opioid exposure. Regional anesthesia fits within multimodal analgesia and contributes to opioid-sparing effects when appropriate, reinforcing the same principle.