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


CONCLUSIONS
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.
Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. conan.mccaul@utoronto.ca
Conan
C
McCaul
Ciaran
C
Moran
Donal
D
O'Cronin
Finola
F
Naughton
Michael
M
Geary
Edmund
E
Carton
James
J
Gardiner
D000328:Adult; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007262:Infusions, Intravenous; D010535:Laparoscopy / Q000009:adverse effects*; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D019354:Sodium Lactate / Q000008:administration & dosage / Q000627:therapeutic use*; D017211:Treatment Failure
D005947:Glucose; D019354:Sodium Lactate