Postoperative nausea and vomiting can be limited in a high-risk population by the use of preoperative intravenous fluid therapy tied to the length of presurgery fasting, reported C.H. Maharaj, M.B., and colleagues from the National University of Ireland, Galway.
Postoperative nausea and vomiting (PONV) can cause great patient distress and increase costs because of the need for additional care. Current treatment options for PONV are limited. More than 25% of patients experience PONV within 24 hours of surgery, according to Dr. Maharaj and colleagues (Anesth. Analg. 2005;100:675-82).
In their randomized, double-blind, controlled study of 80 patients scheduled to undergo diagnostic gynecologic laparoscopy, the researchers compared the effects of preoperative administration of a large volume of compound sodium lactate (2.0 mL/kg per hour of fasting) with a smaller control infusion (single bolus of 3 mL/kg). PONV, pain, and the need to postoperatively administer antiemetics and analgesic drugs were assessed.
The incidence of PONV in the first 72 hours was significantly lower in the 41 patients in the large-volume group (59%) than in the 39 control patients (87%). The number of treated patients needed to prevent an occurrence of PONV was 3.45. Mean postoperative verbal analog scores, nausea scores, pain scores, and mean worst pain scores were significantly lower in the large-volume group than in the control group. In addition, postoperative supplemental analgesic requirements, both in number of patients needing medication and in amount of medication needed, were significantly lower in the large-volume group.