Postoperative Nausea and Vomiting (PONV) was termed __ampersandsignldquo;the big little problem__ampersandsignrdquo; nearly a quarter century ago in an editorial (Kapur et al, 1991). The past decade has witnessed the introduction of several significant innovations to combat PONV, particularly the introduction of serotonin antagonists and the use of combinations of drugs for analgesia and control of PONV. But it still remains as big a problem as before because newer choices and confusions over standardization added side by side. PONV remains a significant problem in modern anesthetic practice also because of adverse consequences such as delayed recovery, unexpected hospital admission, delaqayed return to work of ambulatory patients, pulmonary aspiration, wound dehiscence, and dehydration PONV is controlled by the emetic, or vomiting centre, in the brain. Stimuli are also sent from the cerebral cortex and chemoreceptor trigger zone (CTZ), which is situated in the brainstem. PONV is generally influenced by multiple factors that are related to patient, surgery and anesthesia and which requires release of 5-hydroxytryptamine (5- HT) in a cascade of neuronal events involving both the central nervous system and the gastrointestinal tract. The 5-HT subtype 3 receptor (5-HT3) participates selectively in the emetic response. Patients might become extremely distressed, which in turn can cause them anxiety about undergoing further surgery. PONV also has cost implications in terms of nursing time, delayed recovery, hospital resources and possible re-operation costs. In the present scenario, though we have better understanding and knowledge about the pathophysiology of nausea and vomiting and use of more stable and effective anti-emetics, the postoperative nausea and vomiting (PONV) continues to be the most disturbing complication following surgery and anesthesia.