Upon completion of this activity, participants should be able to:

• Evaluate paradigm-shifting postoperative nausea and vomiting (PONV) developments since ~2010 and apply multimodal prophylaxis strategies (e.g., 5-drug antiemetic protocols with 3-drug postoperative boosters) to achieve target PONV prevention rates of 95% on POD#0 and 90% on POD#1+.
• Explain the clinical rationale for incorporating intrathecal morphine and spinal magnesium in conjunction with multimodal antiemetic regimens and assess their role in reducing reliance on short-term, high abuse-liability opioids.
• Implement a three-analgesic, non-opioid multimodal regimen (when fully administered without missed doses) to optimize postoperative pain control and reduce the use of high abuse-liability opioids, including intraoperative avoidance strategies.
• Analyze the likelihood and clinical implications of rebound PONV associated with routine ondansetron use and select evidence-based alternatives, such as palonosetron, to minimize breakthrough and rebound symptoms.
• Balance the symptomatic trade-offs of intrathecal morphine plus magnesium (ITM+Mg) use by managing associated adverse effects (e.g., pruritus) with targeted treatment strategies and propose research-informed approaches to identify lower abuse-liability opioid alternatives that reduce reliance on ITM+Mg..