Evaluating the effect of perioperative carbohydrate loading on reducing the incidence of PONV in middle ear surgery: a multi-arm randomised controlled trial

Abstract

Background: This study aimed to assess the effect of perioperative carbohydrate loading on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing middle ear surgery.

Methods: This randomised controlled trial included adult patients undergoing middle ear surgery. Patients in group D received 100 ml/hr apple juice until two hours before surgery, followed by 1 ml/kg/hr of 5% dextrose until the end of the procedure. Patients in group NS received 100 ml/hr water until two hours before the operation, then received 1 ml/kg/hr normal saline until the end of the procedure. Patients in group C fasted for six hours and received 500 ml Ringer’s lactate followed by 1 ml/kg/hr intraoperatively. The primary outcome was the incidence of PONV in the first 24 hours (assessed using the Verbal Rating Scale [VRS]). Patients with a VRS score ≥ 5 received ondansetron and then metoclopramide as second-line treatment. Secondary outcomes included antiemetic consumption, nausea severity score, and patients’ satisfaction.

Results: We analysed data from 105 patients (35 patients per group). The incidence of PONV was the least in group D (8, 23%) compared to groups NS (31, 89%) and C (31, 89%), p < 0.001. The severity of nausea was the least in group D compared to the other groups. The total antiemetic consumption was significantly less in group D than in the other groups. Patients’ satisfaction levels were the highest in group D compared to the other groups.

Conclusion: Perioperative carbohydrate loading reduced the risk of PONV in patients undergoing middle ear surgery and improved patients’ satisfaction.