Postoperative Nausea and Vomiting (PONV)

Study Overview

This study looked at whether chewing gum could help treat postoperative nausea and vomiting (PONV) after elective cesarean sections under spinal anesthesia. PONV is a common and distressing complication or Side effect following cesarean deliveries. It can delay recovery, reduce patient satisfaction, and increase healthcare costs.

Background

PONV is a frequent complication for women after cesarean sections. Factors like spinal anesthesia (especially when combined with opioids), blood loss, and the use of uterotonics increase the risk of PONV. Though there are preventive treatments, they are not always effective. Many patients still experience nausea and vomiting, which delays recovery, disrupts bonding with the newborn, and lengthens hospital stays.

Why Consider Chewing Gum?

Chewing gum has been explored as a simple, non-drug treatment for improving gut function after abdominal surgery. Past studies showed that it could reduce symptoms of postoperative bowel slowing (ileus) by helping the intestines start working again. This pilot study wanted to see if chewing gum might also help reduce PONV after cesarean sections.

Study Design

• Type of Study: Pilot randomized controlled trial
• Location: University hospitals
• Participants: Female patients undergoing elective cesarean section under spinal anesthesia
• Intervention: Participants received a standard antiemetic (ondansetron) during surgery and chewed gum after surgery.
• Comparison: Chewing gum was compared with the standard antiemetic ondansetron.

Main Outcomes

• Primary Outcome: The difference in the rate of PONV within the first 24 hours after surgery.
• Secondary Outcomes:
  • Number of nausea or vomiting episodes within 24 hours.
  • Severity of nausea (rated 0–10).
  • Additional antiemetic use after surgery.

Inclusion Criteria

• Elective cesarean section under spinal anesthesia
• Minimum age 18 years
• Willingness to chew gum in the recovery room and for 24 hours post-surgery
• Received ondansetron 4 mg IV during surgery

Exclusion Criteria

• Type 1 diabetes
• Nausea/vomiting upon arrival in the recovery room
• Additional antiemetic medications received during surgery
• Excessive bleeding during surgery (>1000 ml)
• Received ergometrine or misoprostol during surgery
• Received intravenous opioids during surgery

Key Findings

The results showed that chewing gum did not significantly reduce the incidence of PONV within the first 24 hours after a cesarean section.

Discussion

Chewing gum has been studied as a non-drug treatment option in other surgeries and could have benefits in reducing PONV in various settings. However, this study did not find it effective in reducing PONV after cesarean sections. PONV after cesarean deliveries is often influenced by factors like hormonal changes, smoking, age, history of motion sickness, and anesthesia type.

Conclusion

Chewing gum did not significantly lower the rate of PONV after cesarean sections under spinal anesthesia. Further studies are needed to explore other non-drug options, alone or in combination, that could help reduce PONV in this population. The search for effective, non-drug treatments remains important due to the high rates of PONV after cesarean sections.