The Effect of Oral Honey and Water Up to Two Hours Before Surgery on Postoperative Nausea and Vomiting
Condition: Postoperative Nausea and Vomiting
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      Postoperative nausea and vomiting (PONV) remains current as a complication and moderate
      evidence is available regarding the impact of preoperative oral carbohydrate-fluid
      administration on PONV. Honey, a natural source of carbohydrates, has an antioxidative effect
      and protects the gastric mucosa.

      Aim: To investigate the effect of oral honey and water for up to 2 hours preoperatively on
      PONV.

      Methods: A total of 142 elective thyroidectomy (experiment:35; control:37) and laparoscopic
      cholecystectomy (experiment:33; control: 37) patients were included. The experiment group was
      administered a 60 grams honey and 100 ml water mixture up to 2 hours preoperatively. The
      patients were monitored postoperative 0-6 hours using Rhodes Index of
      Nausea-Vomiting-Retching (R-INVR) and visual analog scale (VAS) for PONV.
    

Detailed description: 
      The American Society of PeriAnesthesiology Nurses (ASPAN) describes postoperative nausea and
      vomiting (PONV) as nausea and vomiting within the first 24 hours after an operation and early
      PONV for the first six hours. PONV is a frequent complication of surgical stress, extended
      fasting period and anaesthetic agents and has reported in 30% to 45% of patients, up to 80%
      of the patients at risk groups; especially for people who has gastrointestinal or major
      surgical procedures. Overall, one third of all patients who undergone a surgical intervention
      are said to experience PONV.

      PONV causes discomfort, which may increase anxiety, and can induce indirect or direct pain in
      the individual. This may lead to an increase in intra-abdominal pressure, central venous
      pressure, blood pressure and intracranial pressure, increased risk of cardiac rhythm
      disturbances, and it can lead up to other complications such as risk of aspiration, a
      stretching of the incision. Therefore, the study was planned to evaluate as many variables as
      possible that affect PONV with the use of honey as a source of carbohydrate for the
      carbohydrate solutions (CS). By doing so, supplying carbohydrate to patients with a daily
      source of natural nutrient with its additional benefits of gastric mucosal protection was
      expected to decrease PONV. Honey has been widely used for its medicinal purposes for
      centuries and is suggested for daily intake for gastric protection. It was proved as an
      effective wound care material and rodent studies have showed outstanding results on gastric
      mucosa and ulcer treatment.

      Hypothesis:

      H1. The risk of PONV decreases with honey and water consumption in immediate preoperative
      period.

      H2. Blood sugar level (BGL) is regulated as the fasting period is shortened in patients who
      receive honey orally.

      Intervention:

      The experiment group received 60 g honey in a 190 ml food grade empty glass jars which were
      topped with 100 ml room temperature drinking water and mixed. For standardization of the
      honey content, Turkish Black Chestnut Honey were purchased from a registered producer. The
      honey then was sent to be tested for safety and quality analysis and has found to be within
      the acceptable quality limits of international standards. This information was shared with
      participants.

      The experiment and the control group both were observed for the first 6 hours after surgery
      by the post anaesthesia care unit (PACU) and ward nurses who were blinded to the group
      information.

      Data Collection A data collection form consisting of 23 questions and sub-items including
      participants' demographics and questioning the risk of nausea and vomiting was prepared
      according to the related literature.

      Data collection form;

        1. The demographic chapter comprises; age, gender, educational status, height, weight, body
           mass index, general health status, allergies

        2. Planned surgical intervention and anaesthesia applications; surgery, type and the
           duration of anaesthesia, anaesthetic agents,

        3. Nausea and vomiting risk assessment questions of Koivuranta scale; age, gender, smoking
           status, previous nausea vomiting experience, the duration of anaesthesia,

        4. Post-operative period; complications, a two-hour postoperative pain visual analogue
           scale (VAS), blood sugar levels, drugs for nausea and vomiting,

        5. VAS and Rhodes Index of Nausea, Vomiting and Retching (R-INVR) to examine PONV. The
           Index of Nausea Vomiting and Retching was developed by Rhodes and McDaniel and
           adaptation, validity and reliability in Turkish population of the scale was carried out
           by Tan and Genç (2010).

      The Statistical Analysis:

      The statistical analysis was performed using IBM SPSS 21.0 (IBM Corp. released 2012, Armonk,
      NewYork, USA). Descriptive statistics; mean, standard deviation, median, smallest-largest,
      frequency, percent. In the comparison of discrete variables; Pearson's chi-square and
      Fisher's exact test were used. The suitability of continuous variables to normal distribution
      was evaluated by Kolmogorov Smirnov test. Intergroup comparisons of continuous variables were
      performed by Kruskal Wallis, independent samples t test and Mann Whitney U test. Bonferroni
      corrected Mann Whitney U test was used in paired group comparisons (post hoc) when the
      results of Kruskal Wallis test were meaningful. Intra-group comparisons were performed with t
      test in dependent groups. Pearson and Spearman correlation tests were used to evaluate the
      linear relationship between the variables. A p value of <0.05 was accepted for statistical
      significance.
    

Intervention name(s): Honey and water mixture
Intervention type(s): Dietary Supplement
Intervention description(s): 60 gr of organic Turkish BlackSea Region Chestnut Honey and 100 ml Spring water mixture both mixed in room temperature and ingested up to two hours before the surgery by participants who were "nill by mouth" from midnight prior to the operation day.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled trial with two types of surgery compared, each consisting intervention and control groups.
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: postoperative nausea and vomiting; nursing; oral carbohydrate; honey