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Intravenous fluid loading with or without supplementary dextrose does not prevent nausea, vomiting and pain after laparoscopy

[Une charge liquidienne avec ou sans dextrose supplémentaire ne prévient pas les nausées, les vomissements et la douleur après une laparoscopie]

Conan McCaul, FFARCSI^*, Ciaran Moran, FFARCSI, Donal O’Cronin, FCARCSI, Finola Naughton, FCARCSI, Michael Geary, MD^¶, Edmund Carton, FFARCSI^* and James Gardiner, FFARCSI^*

^* From the Departments of Anaesthesia and
^¶ Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland;
Anaesthesia, The Robert Jones Agnes Hunt Orthopedic Hospital, Oswestry, United Kingdom;
Anaesthesia, Cork University Hospital, Cork, Ireland;
Anaesthesia, Beaumont Hospital, Dublin, Ireland.

Address correspondence to: Dr. Conan McCaul, Departments of Anaesthesia and Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Phone: 416-813-7445; Fax: 416-813-7543; E-mail: conan.mccaul{at}utoronto.ca

Purpose: To examine the effects of iv compound sodium lactate (CSL) with and without caloric supplementation with dextrose on nausea, vomiting and pain following general anesthesia for laparoscopy.

Methods: We compared iv fluid loading with and without supplementary dextrose for the prevention of postoperative nausea and vomiting (PONV). In a prospective double-blinded controlled trial, 120 ASA I female patients undergoing elective gynecological laparoscopy were randomized to one of three groups, and received either: (a) CSL 1.5 mL•kg^-1 per hour fasting duration; (b) CSL, 1.5 mL•kg^-1 per hour fasting duration with 0.5 g•kg^-1 dextrose added in 50% formulation (CSL/dextrose); or (c) no iv fluid (control).

Results: Compared with control the percentage of patients who had no PONV within 24 hr of anesthesia in the CSL and CSL/dextrose groups was 78% vs 83% and 71%, P = 0.81 and P = 0.683 respectively. The numbers needed-to-harm for causing PONV episodes in CSL/dextrose vs CSL or control groups were 5.7 [95% confidence interval (CI), 5.57–5.91] and 8.2 (95% CI, 8.01–8.37) respectively. The number needed-to-treat for prevention of PONV episodes in CSL vs control was 19.2 (95% CI, 19.08–19.37). A greater proportion of patients in the CSL/dextrose group required narcotic analgesia in the postanesthetic care unit compared to those in the control group (16/35 vs 7/37, P = 0.03). The CSL/dextrose group also demonstrated hyperglycemia (serum glucose 14.0 ± 3.94 vs 5.0 ± 1.01 vs 5.2 ± 0.9 mmol•L^-1, P < 0.0001) in the postanesthetic care unit compared to the CSL and control groups. The CSL/dextrose group also reported increased thirst at 24 hr compared to control (20/35 vs 11/37, P = 0.035).

Conclusion: These findings suggest that: 1) administration of dextrose is associated with nausea, increased opioid requirement and late thirst after elective gynecological laparoscopy; 2) iv fluids did not decrease PONV.

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