Preoperative Fasting Abbreviation and its Effects on Postoperative Nausea and Vomiting Incidence in Gynecological Surgery Patients

Abstract

Objective To investigate the effects of preoperative fasting abbreviation with a carbohydrate and protein-enriched solution, on postoperative nausea and vomiting (PONV) incidence in gynecological surgery patients, a population naturally at risk for such unpleasant episodes. Methods The present prospective double-blind randomized study was performed at The Hospital Municipal e Maternidade Dr. Odelmo Leão Carneiro (HMMOLC, in the Portuguese acronym), in Uberlândia, state of Minas Gerais, Brazil, in partnership with the Gynecology Department of the Universidade Federal de São Paulo (UNIFESP), approved by the Human Research Ethics Committee of UNIFESP and the board of HMMOLC, and included in the Brazil Platform and in the Brazilian Clinical Trial Registry. After signing the consent form, 80 women, who were submitted to gynecological surgery in the period from January to June 2016, were randomized into 2 groups: control group (n = 42) and juice group (n = 38). They received, respectively, 200 mL of inert solution or liquid enriched with carbohydrate and protein 4 hours presurgery. The incidence, frequency and intensity of PONV were studied using the Visual Analogue Scale (VAS), with statistical analysis performed by the software IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). Results The incidence of nausea and vomiting was lower than in the literature, to this population, with 18.9% (14/74) for the control group and 10.8% (8/74) for the juice group, respectively, with no statistically significant difference between the groups. Conclusion The incidence of nausea and vomiting was lower than in the literature, but it cannot be said that this is due to the abbreviation of fasting. It can provide greater comfort, with the possibility of PONV prevention in patients at risk for these episodes.

Current practice of postoperative fasting: results from a multicentre survey in China

“…12 Various studies and guidelines have clearly recommended preoperative fasting times, 13 14 and preoperative fasting abbreviation protocols such as enhanced recovery after surgery could avoid nausea, vomiting and ileus and accelerate postoperative recovery. [15][16][17][18] As an important part of perioperative nutrition, early feeding after surgery has been shown to accelerate postoperative bowel function recovery. 19 20 Previous studies have supported early intake after gastrointestinal surgery and total laryngectomy, with some guidelines recommending early oral feeding after surgery.…”

2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting *

“…The body of evidence included 139 studies (adult surgical: 99 randomized controlled trials, 23–34,36–64,68–86,91,118–157 7 nonrandomized trials, 65,66,87,152,158–160 3 prospective cohort studies, 90,161,162 2 retrospective cohort studies, 163,164 1 case-control study, 165 and 2 before–after studies 67,166 ; adult nonsurgical: 1 randomized controlled trial, 167 9 crossover, 168–176 and 2 nonrandomized trials 177,178 ; pediatric surgical: 9 randomized controlled trials, 100,113,179–185 1 prospective cohort 186 ; and pediatric nonsurgical: 2 randomized controlled trial, 102,104 1 crossover, 35 and 1 prospective cohort 103 ) comparing carbohydrate-containing clear liquids (simple, complex) with water, placebo, or fasting. In the carbohydrate arms, liquids were allowed an average of 2.25 h before surgery (80% until 2 h).…”

“…All studied protein-containing clear liquids also contained carbohydrates. The body of evidence included 22 adult surgical studies (20 randomized controlled trials, 32,43,49,52–55,57,64,68,73,76,80,85,91,148–152 1 nonrandomized trial, 90 and 1 retrospective cohort 165 ), 7 adult nonsurgical studies (1 randomized controlled trial 167 and 6 crossover studies 170,171,173–176 ), and 1 pediatric nonsurgical study 104 comparing the effects of drinking protein-containing clear liquids with fasting or noncaloric clear liquids.…”

Enhanced Recovery After Surgery (ERAS) Protocol on Urogynecological Surgeries: 3 years of follow-up after implementation

“…The authors applied in practice the main recommendations from ERAS protocol (Fig. 1), such as abbreviation for preoperative fasting with 400 ml of clear liquid enriched with carbohydrate and protein 4 hours before urogynecological surgeries (preoperative period), according to previous publications, thromboprophylaxis recommendations in addition to other simple practices such as early oral feeding and pain control to facilitate early ambulation (postoperative period) [11][12][13][14].…”