The influence of the ingestion of ice after surgery on pain and nausea and vomiting.

Postoperative pain and postoperative nausea and vomiting (PONV) are common after surgery and a large burden to patients. Not only the site of surgery may be painful but also anesthesiological interventions, like intubation and the insertion of an urinary catheter may result in discomfort after surgery. For example, oral intubation may lead to a sore throat and hoarseness and the placement of a urinary catheter may result in discomfort in the urinary tract. PONV is often caused by surgical interventions in the abdomen but also drugs necessary to induce anesthesia result in postoperative nausea and vomiting.



The management of postoperative pain and PONV is one of the tasks of the recovery personnel under supervision of the anesthesiologist. Management of postoperative acute pain is often by the administration of opioids (which by themselves are a main cause of PONV). PONV is treated by the administration of anti-emetic drugs. In addition to pharmacological interventions, non-pharmacological interventions may be very useful in the treatment of postoperative pain and PONV. However, currently, non-pharmacological interventions are not routinely used in the recovery room for the management of pain or nausea and vomiting, possibly because their effectiveness has never been investigated. Non-pharmacological interventions have been successfully used in the first week after surgery. For example, it has been shown that chewing gum in the first week after abdominal surgery reduces the development of postoperative ileus.1



In the current study we will investigate the effect of non-pharmacological treatment on postoperative acute pain and PONV in patients undergoing a laparoscopic cholecystectomy. Patients will receive an ice-lolly, chewing gum or no non-pharmacological treatment in the postoperative phase. We believe that this non-pharmacological treatment can reduce the stress level of patients direct postoperative and can give distraction from the pain and nausea. This may result in a reduction of pain intensity levels and analgesic consumption and a lower incidence of PONV in patients using ice-lolly or chewing gum postoperatively.

We hypothesize that:

1) Patients receiving an ice-lolly or chewing gum directly postoperative will have lower pain intensity scores in the 24 hours following surgery compared to no non-pharmacological treatment.

2) Patients receiving an ice-lolly or chewing gum directly postoperative will have a reduced analgesic consumption in the 24 hours following surgery compared to no non-pharmacological treatment.

3) Patients receiving an ice-lolly or chewing gum directly postoperative will have a lower incidence of PONV and need less anti-emetic drugs in the 24 hours following surgery compared to no non-pharmacological treatment.

All outcome parameters will be measured at predefined time points: 15 minutes prioir to surgery and at 0, 15, 30, 45 and 60 minutes and 3, 12 and 24 hours after the end of anesthesia.

The study will have two interventions:

1) ingestion of an ice-lolly direct post-operative

2) 20 minutes chewing of chewing gum direct post-operative

11-dec-2016: Due to too severe postoperative sedation we cancelled the chewing gum intervention arm. In the first 3 patients who received chewing gum 2 patients fell asleep during chewing of the gum which was considered too dangerous by the investigators due to the risk of airway obstruction by the gum. Therefore, the study arm with chewing gum as intervention was removed from the study.