Effect of Preoperative Carbohydrate Drink and Postoperative Chewing Gum on Postoperative Nausea and Vomiting in Patients Undergoing Day Care Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Background Postoperative nausea and vomiting (PONV) causes an unexpected prolonged hospital stay after ambulatory surgery. Novel measures such as preoperative loading of oral carbohydrates and postoperative chewing gum have recently gained momentum for postoperative recovery. This study evaluated the effects of preoperative carbohydrate loading and postoperative chewing gum (CG) on PONV after daycare laparoscopic cholecystectomy (LC). Methods A total of 100 patients were randomized to group A (preoperative carbohydrate loading with 200 ml of water with 25 g of carbohydrate and postoperative chewing gum (CG) when the patient responded to his/her name) and group B (standard care). The incidence of PONV and pain was assessed by using visual analogue scale. Quality of recovery (QoR-15) was assessed by using QoR15 questionnaire at 6 h, 24 h and 48 h after surgery. Results The incidence of PONV and pain was lower in group A; however, it was not significant (p [ 0.05). The severity of PONV, pain and the need for rescue antiemetic was significantly lower in group A (p \ 0.05). The episodes of PONV and required dose of antiemetic were less in group A. Group A also had a significantly higher QoR-15 score at all time points (p \ 0.001). Preoperative dyspepsia was also noticed as a significant confounding predictor for postoperative vomiting. Conclusion Preoperative carbohydrate drinks and early postoperative CG reduces the severity of PONV and requirement of antiemetics in patients undergoing LC. Hence, these simple measures can be used as a standard of care to optimize perioperative care in patients undergoing daycare surgery.

Letter to the Editor: Effect of preoperative carbohydrate drink and postoperative chewing gum on postoperative nausea and vomiting in patients undergoing day care laparoscopic cholecystectomy: A randomized controlled trial

“…Third, other than oral paracetamol 500 mg daily, intravenous diclofenac 75 mg was only administered as a rescue analgesic. According to the data provided in Table 3 of Balabolu et al' article, 1 we noted that mean Visual Analog Scale pain scores were 5.0-6.1, indicating that a significant proportion of patients have moderate to severe postoperative pain. This is not the successful use of the best Enhanced Recovery after Surgery practices, which require that an effective multimodal analgesia strategy is an important component of multimodal prophylaxis for PONV.…”

“…To the Editor, By conducting a randomized controlled trial of 100 patients who underwent day care laparoscopic cholecystectomy, Balabolu et al 1 demonstrated that preoperative carbohydrate drinks and early postoperative chewing gum significantly reduced the severity of postoperative nausea and vomiting (PONV) and the requirement of antiemetics. Given that PONV remains common and distressing postoperative complications with delayed recovery and increased use of healthcare resources, 2 their findings have important clinical implications.…”