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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