Apfel Score for Post-Operative Nausea & Vomiting
Predicts risk of post-operative nausea and vomiting (PONV) to guide prophylactic antiemetic therapy. Each risk factor adds ~20% to baseline risk.
Score interpretation
0–1 risk factors — PONV risk ~10–20%
→ No routine prophylaxis needed; consider TIVA (total IV anaesthesia) for high-risk procedures
2 risk factors — PONV risk ~40%
→ 1–2 antiemetic prophylactic agents (e.g., ondansetron + dexamethasone); consider TIVA
3–4 risk factors — PONV risk 60–80%
→ 2–3 multimodal antiemetics; TIVA strongly preferred; minimise intraoperative opioids; consider regional anaesthesia
Interpretation bands for the Apfel Score. Apply clinical judgement and local guidance.
References
- Apfel CC et al. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology. 1999;91(3):693–700.
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
- Metoclopramide (Perioperative PONV) · Dopamine D2 Antagonist / Prokinetic (Antiemetic)
- Difluprednate 0.05% Eye Drops · Potent Ophthalmic Corticosteroid — Uveitis / Post-Operative Inflammation
- Bromfenac · Topical NSAID (post-operative)
- Oxycodone (Orthopaedic Post-operative Pain) · Opioid Analgesic — Strong
- Acute Liver Failure · EASL 2017 / BSG
- Decompensated Cirrhosis · BSG 2015 / EASL 2018
- IBD Acute Flare Assessment · ECCO / BSG 2019
- Hepatitis B Management · EASL 2017 / NICE NG33
- Dysphagia Assessment Pathway · BSG 2010 / NICE NG12
- Sodium channel blocker / LAST · AAGBI Safety Guideline 2010 (LAST); TOXBASE/NPIS; ESC
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.