The effect of intravenous dextrose administration for prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy: A double-blind, randomised controlled trial

Abstract

Background and Aims:Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC.Methods:In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery.Results:There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores (P < 0.05). A low negative correlation coefficient was found (r = −0.394, P < 0.001) between blood glucose levels and nausea scores upon PACU arrival. Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: −0.87, odds ratio = 0.42, 95% confidence interval: 0.28–0.64).Conclusion:Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC.

Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis

“…Eleven articles with 1,250 patients were included in this meta-analysis ( Fig 1). [10][11][12][24][25][26][27][28][29][30][31] Of the 11 articles, 10 were in English, and 1 was in Korean.…”

“…The features of the 11 RCTs are presented in Table 1. The participants were only women in 6 RCTs [11,12,24,[27][28][29], and 92.2% of the participants in this meta-analysis were women. All participants included were ASA1-2.…”

“…The type of surgery in 9 RCTs was laparoscopic surgery. [10,12,24,25,[27][28][29][30][31] In 8 RCTs, [12,[24][25][26][27][28][29]31] the dextrose dose was > 12.5 g. In 3 RCTs, [10,12,31] prophylactic antiemetics were administered. One RCT [25] was an abstract-only publication.…”

“…The risk of bias in the included trials is summarized in Table 2. No RCT was considered to have a low risk of bias, 3 RCTs were considered to have a high risk of bias, [25,26,28] and the rest had an unclear risk of bias. The details on each evaluation were reported in the S1 File.…”

“…Eight RCTs with 750 patients were analyzed for the intravenous dextrose effects on the incidence of early rescue use. [10][11][12]24,[27][28][29]31] Combined results revealed that the incidence of early rescue use did not differ between the dextrose and control groups, with high heterogeneity (RR [95% CI] = 0.70 [0.44 to 1.12], I 2 = 70%, S4A Fig). A small-study effect was not detected with the regression test for funnel plot asymmetry (P = 0.14).…”