Purpose PONV is common after bariatric surgery, involving neurohormonal and vagally-mediated mechanisms triggered by surgical alteration of gastric anatomy. We adopted a novel approach of intraperitoneal blockade of the anterior Vagus nerve (VNB) from a recent study that showed a substantial reduction in PONV following VNB in laparoscopic sleeve gastrectomy [1]. Despite obvious improvement with this innovation, some patients still suffered from PONV. Therefore, we introduced the neurokinin-1 inhibitor (NKI) antiemetic Fosaprepitant as part of our anaesthetic. Methodology We conducted a three-phase prospective clinical audit of PONV in PACU and Day 1 post-op, following the sequential introduction of 3 separate techniques in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB). Phase one involved spraying the gastric staple lines and lesser omentum with intraperitoneal bupivacaine (IPB). Phase two involved replacing the first technique with a laparoscopic VNB using bupivacaine injected at 6 points along the Vagus nerve. The third approach added Fosaprepitant to the VNB (VNB+F). Outcomes included the presence of nausea and vomiting in PACU and on Day 1 post-op, and interference with ADLs. Patients were included between April 2022 to December 2025. Results Ninety-two patients were enrolled: 62 for LSG, 30 for LGB. In LSG, PACU nausea was 21% in VNB, 32% in VNB+F and 63% in IPB. In LGB, nausea in PACU was 0% in VNB+F, 35% in VNB and 46% in IPB. Vomiting in PACU was negligible overall. In both procedures, vomiting over 24 hours was absent in VNB+F. Reported interference with ADLs progressively decreased across the three interventions, reaching 0% in VNB+F. Conclusion The addition of VNB and Fosaprepitant to a standard antiemetic regimen may reduce nausea in recovery and facilitate a faster return to function following bariatric surgery. Prospective controlled trials are warranted. References [1]Daes J et al. Obes Surg. 2022;32(11):3551–3560.