Role of Intravenous Dextrose on Reducing PONV in Children Undergoing Tonsillectomy and /or Adenoidectomy
An-Najah National University
Background. Post-operative nausea and vomiting (PONV) is the most frequent complication of Tonsillectomy and /or Adenoidectomy surgeries and is the major cause for readmissions and increase the length of stay in hospital. Aims. The aims of the study are to evaluate the effect of postoperative administration of IV 5% dextrose on the incidence and severity of nausea, and incidence of vomiting in patients undergoing tonsillectomy/adenoidectomy and its effect on the incidence of another postoperative symptoms that are (pain, headache, drowsiness, fatigue, thirst, hunger and bleeding) and consumption of rescue antiemetic and rescue analgesia medications. Methods. A prospective, randomized, controlled double-blind clinical trial in 90 Pediatric patients, aged 4-12 years, American Society of Anesthesiologist (ASA) physical status I and II. Patients undergoing adeno/tonsillectomy surgery under general anesthesia, were randomly assigned into two groups (n = 45 each). Group one, dextrose water (DW) group, and group two, ringer lactate (RL) group. The incidence of postoperative symptoms focusing on the incidence and severity of nausea, and frequency of vomiting and the need for “rescue” medications are assessed at specific time intervals from 30 mints post operation until discharge. Results. Intravenous dextrose water given postoperatively had a significant effect on decreasing the incidence of post-operative nausea at 30 mints (P-value 0.000), 1st hr after operation ( P= 0.001) and the overall incidence of nausea (0-5 hr) was significantly lower in DW group 23(48.9%) compared to the RL group 35(77.8%), p= 0.004. Moreover, The results indicated that 5% DW administered postoperatively reduces the intensity of nausea at 30 min, one hour, and on discharge from the hospital M±S.D of VAS-N scale in the DW group (0.04±0.3) is significantly lower than the RL group (0.4+0.91), p=0.015. Although there is a significant difference in the incidence of complete response in the dextrose group 23(51.1%) compared to RL group 10(22.2%), P=0.004 at 0-5 hrs. There is a significant difference for use of rescue antiemetic drug of Ondansetron on the whole entire period of the study (0-5 hrs.) between the dextrose group 7(15.6%) compared to Ringer lactate group 17(37.8%), p=0.017. The incidence of headache in overall period (0-5 hr.) in the DW group (0%(0)) is significantly lower compared to RL group 6(13.3%), p= 0.011. Also, the incidence of headache at 2hrs in the DW group (0%(0)) versus RL group 5(11.1%), P= 0.0. In the overall period (0-5 hrS.),the number of patients with drowsiness in the RL group 36(80%) is significantly higher than the DW group 8(17.8%), p= 0.000, at 30 mints after operation in the DW group 5(11.1%)versus RL group 16(35.6%), p= 0.006, at 1hrs. After operation in the DW 3(6.7%) is significantly lower than the RL group 19(42.2%), P= 0.000. Like some drowsiness at 2 hrs. after operation in the Dw 0(0%) is significantly lower than RL group 8(17.8%), p=- 0.003. The incidence of fatigue in the DW group is significantly lower than in the RL group at 30 minDW group 3(6.7%) versus the RL group 10(22.2%), p=0.036, one hour DW group 0(0%) versus the RL group 4(8.9%), p=0.041 and 4 hours postoperatively DW group 0(0%) versus RL group 4(8.9%), p=0.041. Thirst at 3 hrs. after operation in the DW group 4(8.9%) is significantly lower than the RL group 11(24.4%, ) p= 0.048, and at 4 hrs., the DW group 4(8.9%) versus the Ringer lactate group 11(24.4%), p=0.000, like some, number of patients with thirst at discharge in the DW group 1(2.2%) is significantly lower than the RL group 7(15.6%), p=0.026, also the overall period, the number of patients who were thirsty in the RL group 38(84.4) is significantly higher than the number of patients who were thirsty in the DW group 13(28.9%), p= 0.000. Hunger at 3 hrs. after the operation in the DW group 2(4.4%) is significantly lower than the RL group 18(40%), p= 0.000, and hunger in 4 hr DW group 9(20%) versus the RL group 23(51.1%), p= 0.002. In the overall period (0-5 hr.), the number of patients who were hungry in the RL group39 (86.7%) is significantly higher than the number of patients who were hungry in the DW group19 (42.2%), p= 0.000. Conclusion. The administration of intravenous dextrose postoperatively for pediatric patients undergoing adeno/tonsillectomy reduces the incidence and the Intensity of nausea, the consumption of rescue medication, incidence of headache, fatigue, thirst, hunger and had no significant effect on the incidence of vomiting, and the incidence and intensity of pain.
Dextrose water 5% , Postoperative Nausea , Vomiting; Pain , Headache , Drowsiness , Thirst , Hunger