The effectiveness of pre-operative oral carbohydrate drink on post-laparoscopic cholecystectomy nausea and vomiting

Abstract

Background: The ideal anaesthetic for laparoscopic surgery such as laparoscopic cholecystectomy is the use of general anaesthesia (GA). GA comes with several common side effects usually occurring post-operatively such as postoperative nausea and vomiting (PONV). Locally, the patient preparing for a procedure under general anaesthesia is required to fast in order to diminish the stomach contents and acidity and therefore helps in minimising the incidence of regurgitation and pulmonary aspiration. Literature has discussed that providing an isotonic, carbohydrate-rich clear fluid preoperatively can aid in controlling the metabolic response, resulting in improved clinical outcomes such as reduction in the incidence of PONV. Objective: To determine whether preoperative oral carbohydrate loading reduces the incidence of PONV in patients undergoing laparoscopic cholecystectomy compared to fasting. PICO Question: “In an adult undergoing laparoscopic cholecystectomy, does the intake of oral preoperative carbohydrate drinks reduce postoperative nausea and vomiting compared to fasting?” Method: Relevant studies addressing the proposed PICO question were obtained using a combination of keywords in multiple databases and search engines. A total of four randomised control trials (RCTs) fitting the inclusion and exclusion criteria were retrieved. The population of this study was of adult patients of eighteen years or older undergoing laparoscopic cholecystectomy. The intervention was ingestion of preoperative carbohydrate drinks, to reduce PONV as an outcome in comparison with fasting patients. Search was limited to the articles in English language published in the last ten years to exclude outdated research. Results: All articles retrieved had their own limitations. Inconclusive results were found with two RCTs concluding that ingestion of carbohydrate drinks preoperative decreased the incidence of PONV whilst the other two RCTs showed no beneficial effects when it comes to PONV. Therefore, a conclusion couldn’t be taken which could be why such practice is not adopted locally. Conclusion: The inconclusive answer to the PICO question shows the need for further research to be able to conclude whether preoperative oral carbohydrate drinks decreases the incidence of nausea and vomiting.