Apfel Score (Post-operative Nausea and Vomiting)
Predicts risk of post-operative nausea and vomiting (PONV). Guides prophylactic antiemetic strategy.
How to use & interpret
The Apfel score estimates the risk of postoperative nausea and vomiting (PONV) from four factors: female sex, non-smoker, a history of PONV or motion sickness, and the expected use of postoperative opioids. Each present factor scores one point (0–4).
The score corresponds to roughly 10%, 20%, 40%, 60% and 80% risk for 0–4 factors and guides how many prophylactic antiemetic strategies to use (and whether to modify the anaesthetic, e.g. TIVA, opioid-sparing techniques).
Score interpretation
→ No prophylaxis or single antiemetic (ondansetron); TIVA not required
→ Two antiemetics (ondansetron + dexamethasone); consider TIVA if feasible
→ Triple prophylaxis: ondansetron + dexamethasone + droperidol/cyclizine; TIVA strongly recommended; scopolamine patch
Interpretation bands for the Apfel PONV Score. Apply clinical judgement and local guidance.
Frequently asked questions
How does the Apfel score change management?
Higher scores justify multimodal PONV prophylaxis (combining antiemetics from different classes) and anaesthetic techniques that reduce risk, such as total intravenous anaesthesia and opioid-sparing analgesia.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Cyclizine (Nausea and Vomiting in Pregnancy) · Antihistamine Antiemetic — Hyperemesis Gravidarum
- Prochlorperazine (Nausea and Vomiting in Pregnancy) · Phenothiazine Antiemetic — Hyperemesis Gravidarum
- Ondansetron (Paediatric) · 5-HT3 Receptor Antagonist — Nausea / Vomiting / Gastroenteritis
- Ondansetron · Antiemetic — 5-HT3 Antagonist
- Ondansetron · Antiemetic
- Ondansetron (Hyperemesis Gravidarum) · 5-HT3 Receptor Antagonist (Antiemetic — Hyperemesis Gravidarum)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.