"Effective in preventing preoperative chewing gum and postoperative vomiting"
Aug 26, 2024
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Postoperative nausea and vomiting (PONV), known to be experienced by about 30% of all surgical patients, are responsible for slowing patients' recovery and increasing treatment costs. Recently, the number of patients suffering from PONV symptoms is increasing as minimally invasive surgery that injects carbon dioxide into the abdominal cavity during surgery has increased to secure visibility in narrow surgical spaces.
A research team led by Professor Ko Hyun-jung (corresponding author) and Chae Min-seok (first author) of the Department of Anesthesiology and Pain Medicine at the Catholic University of Korea's Seoul St. Mary's Hospital analyzed 88 female patients who underwent robotic-assisted laparoscopic surgery to remove benign ovarian tumors, and found that the need for antiemetic drugs decreased in 44 groups who chewed sugar-free gum for 15 minutes just before the surgery.
Nausea and vomiting that occur after surgery are not serious life-threatening complications, but are common distressing and unpleasant symptoms. In the case of clinical risk factors (women, smokers, and patients with motion sickness experience), the proportion is known to rise to more than 70%. Accordingly, various preventive measures, including antiemetic prescriptions or anesthesia using propofol, are recommended for patients with at least one risk factor.
In addition to drug methods, various non-pharmaceutical interventions are among the preventive measures to prevent vomiting, and one of them is 'chewing gum'. According to several meta-research, including the Cochrane Review, which is highly authoritative in the medical community, chewing gum after surgery has been acknowledged to have a positive effect on increasing gastrointestinal movement, preventing bowel twisting and promoting recovery.
The research team based on this study evaluated the efficacy of chewing gum in surgery 'before' rather than chewing gum 'after', which has been studied so far. Participants in the study classified into experimental groups (the preoperative gum-chewed group) and control groups (the preoperative gum-chewed group) by random assignments were chewing sugar-free gum for 15 minutes under controlled environments immediately before surgery, and all medics evaluating postoperative outcomes were conducted in a 'tolerant single-blind randomized controlled trial' manner with no knowledge of group assignments.
Through this study, the research team confirmed the positive effect of chewing gum before surgery. When comparing the group who did not chew gum and the group who chewed gum before surgery, it was confirmed that the rate of administration of anti-vomiting agents was 20.5% (9 patients) and the rate of administration of second-line treatments due to severe vomiting was also low at 47.7% (21 patients).
Meanwhile, in 2014, the American Society of Anesthesiologists (ASA) announced at its annual meeting that chewing gum during the preoperative fasting period was safe without increasing postoperative complications. In addition, in 2023, the revised edition of the `Preoperative Instructions for Fasting in Medicine" states that healthy adults do not have to postpone their operations even if they chew gum before surgery, and do not specifically increase the risk of aspiration pneumonia.
Professor Ko Hyun-jung, who led the study, said, "Although minimally invasive robotic and laparoscopic surgeries have many benefits, the focus of the study is to reduce the problem of increasing patients experiencing vomiting due to intraperitoneal injection of carbon dioxide (CO2) through non-pharmaceutical intervention. "Although the question of whether to allow patients to voluntarily chew gum during the preoperative fasting period is still somewhat cautious, we hope that various follow-up studies will be conducted as planned chewing gum in a well-controlled environment by medical staff seems to be helpful." he said.
The study was published in the recent issue of the international journal `Medicina.'
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