Early Postoperative Oral Fluid Intake in Paediatric Day Case Surgery Influences the Need for Opioids and Postoperative Vomiting: a Controlled Randomized Trial

Chauvin C, Shalber-Geyer AS, Lefebvre F et al.

British Journal of Anaesthesia 2017; 118 (3): 407-414

Aim of Study

Stated hypothesis: Evaluate the influence of early postoperative oral fluid intake on the use of opioid analgesics and the incidence of postoperative vomiting (POV) after paediatric day case surgery.

Design (& Location)

Prospective randomised control of day case paediatric surgery (Germany)

Methodology

Planned day surgery patients aged 6 months to 4 yr were randomized to the liberal group (LG), in which apple juice (10 ml kg−1) was offered first if the Face Legs Activity Cry Consolability (FLACC) score was ≥4 in the PACU, or to the control group (CG), in which children were treated after surgery according to the institutional opioid protocol, and drinking was allowed only upon the return to the ward. Bayesian statistical analysis was used to compare POV incidence and opioid use across groups.

Primary Outcome

Incidence of POV in both groups in first 3 days post op

Secondary Outcomes

Amount of opioids needed in both groups

Length of stay in PACU

Post op adverse effects

Statistics

Bayesian statistical analysis

Results

Data from 231 patients were analysed. The incidence of POV in the LG and the CG was 11.40 and 23.93%, respectively.

An opioid was needed in 14.04% and 35.89% of the patients in the LG and the CG.

The PACU stay was 53.45 and 65.05 min in the LG and the CG, respectively

(all differences were statistically significant).

Conclusions/Discussion

If apple juice offered – significant reduction in: POV incidence, post op opioids and recovery stay

Stated Limitations from Study

Unblinded

Study stopped early

Unable to distinguish between causes of maladaptive post anaesthesia behaviour

Discussion from Journal Club Meeting (?Change of Practice?)

We don’t have set opioid protocol for paediatric patients but is one needed?

Appears majority of their patients are urological whereas at Kingston it is ENT (higher incidence of POV)

Should we start offering juice earlier?

Summary by Dr H Sivadhas. Journal Club Meeting 22 March 2018.

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