Do Fluids Lead to Post-Op Nausea and Vomiting?

Nauseous and vomiting patients aren’t going to be so happy…neither is the hospital that has to delay discharge. A new study examines what might affect this situation: “Effects of Preoperative Carbohydrate-rich Drinks on Immediate Postoperative Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial,” was published in the June 1, 2022, edition of The Journal of the American Academy of Orthopaedic Surgeons.

Jonathan H. Shaw, M.D, a fourth-year orthopedic surgery resident at Henry Ford Health System in Detroit, Michigan, and co-author for this study explained the genesis of this study to OTW, “Due to the increasing demand to optimize orthopedic care and funding, there is now an emphasis on the standardization of total joint arthroplasty protocols.”

“Enhanced recovery after surgery protocols have been utilized in other surgical specialties. Part of the protocol is controlling patient’s nausea and vomiting postoperatively as this can delay discharge and in general be dissatisfying while recovering.”

“There is some evidence that NPO [nothing by mouth] status may contribute to patient’s postoperative nausea and vomiting, but this has not been investigated in the orthopedic literature. Therefore, this study was designed to investigate consuming a carbohydrate-based drink up to the time of surgery and see if this improves postoperative nausea and vomiting and well as outcome measures.”

Dr. Shaw and other members of the research team enrolled 153 patients who were being treated with total knee arthroplasty (TKA) at Henry Ford into the study.

Dr. Shaw delineated the study groups to OTW, saying, “This was a randomized controlled trial that was designed to investigate three groups: Group A (intervention group; n=50) received a clear, non- carbonated lemon-flavored, iso-osmolar carbohydrate drink, Group B (placebo group; n=51) received a placebo drink, and Group C (control group; n=52) received no drinks.”

“We determined that between the three groups there was no significant change in postoperative nausea and vomiting. However, importantly, we found that those taking the carbohydrate drink had no increased intraoperative or postoperative anesthesia complications, which is the basis of the NPO [nothing by mouth] status preoperatively.”

“For patients undergoing spinal/regional anesthesia, which is the majority of primary joint arthroplasty procedures, this challenges whether these patients need to discontinue drinking fluids the night before surgery. Most arthroplasty patients are in their older years and can dehydrate very quickly, so subjects like this are important for this patient population.”

“Albeit the primary outcome demonstrated no significant difference,” says Dr. Shaw, “there was also no increased intraoperative or postoperative complications in the cohort that drank fluids up to the time of surgery. This begs the question whether patients need to discontinue fluids preoperatively before undergoing total joint arthroplasty. More studies are necessary with this being the primary outcome.”