PONV is common following laparoscopic surgery and is thought to be caused by stimulation of mechanoreceptors in the intestine secondary to abdominal gas insufflation. This gas insufflation leads to serotonin release and activation of 5-HT3 receptors. The consequences of PONV include dehydration, electrolyte imbalances, bleeding, and surgical wound disruption, which can all contribute to morbidity. Various pharmacological interventions have been tried in order to alleviate or prevent PONV; however, their efficacy is debatable.

Investigators conducted a meta-analysis to systematically assess the effects of perioperative dextrose infusion on preventing PONV in patients undergoing laparoscopic surgery. The meta-analysis included randomized control trials (RCTs) with a perioperative dextrose infusion and a control group administered to patients undergoing laparoscopic surgery while under general anesthesia. These studies included as their main outcomes the incidence of PONV, need for rescue antiemetics, and postoperative blood glucose levels. Studies were excluded if they were nonclinical trials, had incomplete data, or if they were case reports, reviews, letters, or conference abstracts.

A search of Web of Science, Google Scholar, PubMed, and EMBASE databases from inception to November 10, 2020 yielded six studies, which included a total of 526 patients.

Four of the six RCTs, which included 356 patients, examined the incidence of PONV. There was a statistically significant 39% reduction in the incidence of PONV in the dextrose group compared with the control group (risk ratio, also known as relative risk [RR] = 0.61, 95% CI: 0.39-0.95, P = .03). Five of the six RCTs, which involved 455 patients, examined the use of antiemetics. Investigators found a statistically significant 47% reduction in the use of antiemetics in the perioperative glucose infusion group (RR = 0.53, 95% CI: 0.42-0.66, P <.00001). Three of the six RCTs, which represented 306 patients, examined glucose levels following the dextrose infusion. There was no significant increase in blood glucose level in those who received the perioperative glucose infusion versus the control group (mean difference [95% CI] = 74.55 [-20.64-169.73] mg/dL). There was also no evidence of publication bias and upon sensitivity analysis, and the included studies were found to be reliable and stable.

This study lends support for the use of perioperative glucose infusion to prevent PONV associated with laparoscopic procedures. While the mechanism by which glucose improves PONV is not clear, it is thought to be due to a reduction in hyperglycemia-induced gastric acid secretion via regulation of vagal cholinergic pathways or by increasing plasma cholecystokinin levels; increases in plasma cholecystokinin levels are associated with reductions in pain and PONV.

Although limited by the inclusion of few clinical trials, the results of this meta-analysis are encouraging. Pharmacists should be knowledgeable of the use of perioperative glucose infusion as another therapeutic intervention to help manage PONV.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

« Click here to return to Infusion Pharmacy Update.