Apfel Score for Postoperative Nausea and Vomiting
Simplified Apfel score predicts risk of postoperative nausea and vomiting (PONV). Four independent risk factors guide prophylactic antiemetic prescription.
Score interpretation
→ Apfel Low Risk (0–1): ~10–20% PONV risk. Consider single-agent prophylaxis (ondansetron 4 mg or dexamethasone 8 mg) if desired. Maintain adequate hydration; minimise opioids with regional analgesia if possible.
→ Apfel Moderate Risk (2): ~40% PONV risk. Dual antiemetic prophylaxis: ondansetron 4 mg IV + dexamethasone 8 mg IV at induction; consider TIVA (propofol) over volatile agents; minimise opioids; adequate hydration.
→ Apfel High Risk (3–4): 60–80% PONV risk. Triple or multimodal antiemetic prophylaxis: ondansetron + dexamethasone + scopolamine patch or haloperidol; TIVA strongly recommended; regional anaesthesia to reduce opioids; avoid nitrous oxide; post-op ondansetron PRN.
Interpretation bands for the Apfel PONV Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Ondansetron (Paediatric) · 5-HT3 Receptor Antagonist — Nausea / Vomiting / Gastroenteritis
- Cyclizine (Nausea and Vomiting in Pregnancy) · Antihistamine Antiemetic — Hyperemesis Gravidarum
- Prochlorperazine (Nausea and Vomiting in Pregnancy) · Phenothiazine Antiemetic — Hyperemesis Gravidarum
- Dexamethasone (Orthopaedic — PONV and Opioid-Sparing) · Corticosteroid — Anti-emetic and Opioid-Sparing
- Ondansetron (Perioperative) · 5-HT3 Receptor Antagonist (Antiemetic)
- Dexamethasone (PONV Prevention) · Corticosteroid (Antiemetic)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.