The Influence of the Post-operative Ingestion of an Ice-lolly on Pain, Analgesic Consumption 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 are 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. Besides 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 on the recovery 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.

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 on the recovery an
ice-lolly, chewing gum or no non-pharmacological treatment. We believe that
this non-pharmacological treatment may reduce the stress level of patients
direct postoperative and will 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.

We hypothesize that:
1) Patients receiving an ice-lolly or chewing gum direct 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 direct 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 direct 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.*

Each patient will be randomized to receive either an ice-lolly (n = 50),
chewing gum (n = 50) or no non-pharmacologic treatment (n = 50). The
non-pharmacological treatment will start 15 minutes after the arrival at the
recovery to make sure the patients are awake and able to follow instruction
regarding the intervention.

Ice-lolly: patients will receive an ice-lolly in a taste of their preference.
Chewing-gum: patients will receive chewing gum for 20 minutes
During the interventions a nurse will be present for safety in case patients
are still drowsy from the anesthesia.

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