EARLY DISCONTINUATION OF ‘NIL BY MOUTH’ REDUCES THE INCIDENCE OF POST-OPERATIVE NAUSEA AND VOMITING
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Keywords
PONV, NBM, post-operative, early discontinuation.
Abstract
Introduction - The mandatory ‘Nil by Mouth’ (NBM) practice perioperatively aims to reduce the gastric volume and acidity. This reduces the risk of pulmonary aspiration and thus provides safe anaesthesia. Aspiration of ≥25ml or pH≤ 2.5 of the gastric contents, might cause serious consequences. Our study was done to assess the effect of early discontinuation of post-operative NBM period on Post Operative Nausea Vomiting (PONV). This is in accordance with Enhanced Recovery After Surgery (ERAS) concept, fast tracking discharge from Post Anaesthesia Care Unit (PACU). Methodology-The study was conducted at a tertiary care centre. Patients were divided in 2 groups : 60 participants in Standard Group (S-Group) where conventional post-operative NBM period was observed and 60 participants in Early post-operative Discontinuation Group (D-Group) where post-operative NBM discontinuation was done within two hours of shifting to PACU. Patients fulfilling the inclusion criteria were selected randomly for the study and underwent a thorough pre-anaesthesia evaluation. The standard general anaesthesia protocol was followed along with Opioid (Inj. Fentanyl 2mcg/kg IV), Prophylactic antiemetic medication (Inj.Dexamethasone 0.1mg/kg IV after induction was given and Inj. Ondansetron 4mg IV was administered before extubation). Sips of water and subsequent clear liquids were introduced to D-Group patients within two hours of extubation and semisolids or a soft diet was introduced later. The scale and score were used to rate the incidence of PONV in both groups. Results- Incidence of PONV was 71.7% and absent among 28.3% in S-Group. While in D-Group, incidence of PONV was 38.3% and absent among 61.7%. There was significant difference between two groups regarding incidence of PONV(p-value- 0.0001). Alongwith the incidence; the severity of PONV was significant in S-Group than D-Group. We will remove bracketed participants, only percentage will look better. Conclusion- Early discontinuation of post-operative NBM reduced incidence and severity of PONV.
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