One of the most common and upsetting side effects after general anesthesia surgery is still postoperative nausea and vomiting (PONV). PONV is still a major issue for anesthesiologists and surgeons, despite the fact that improvements in anesthetic procedures, pharmaceutical agents, and perioperative care have greatly improved surgical results. In the general surgical population, the reported prevalence of PONV is between 20% and 30%; in high-risk patients undergoing laparoscopic procedures, it might reach 70–80%. PONV has a substantial impact on postoperative recovery, patient satisfaction, and healthcare expenses, and patients frequently view it as more unpleasant than postoperative pain.

Due to its minimally invasive nature, decreased postoperative pain, shorter hospital stay, and quicker return to normal activities, laparoscopic cholecystectomy is considered the gold standard treatment for gallbladder disorders and symptomatic cholelithiasis. Despite these advantages, laparoscopic cholecystectomy is associated with a very high risk of PONV. Pneumoperitoneum with carbon dioxide insufflation, manipulation of abdominal viscera, use of volatile anesthetic agents, perioperative opioid administration, the predominance of female patients undergoing cholecystectomy, and the inherent emetogenic effects of general anesthesia are some of the factors that increase this risk. Therefore, PONV prophylaxis continues to be a crucial part of enhanced recovery after surgery (ERAS) protocols.

Complex connections between central and peripheral brain circuits are part of the multifaceted pathophysiology of PONV. The vestibular apparatus, cerebral cortex, gastrointestinal tract, and chemoreceptor trigger zone (CTZ) provide afferent input to the vomiting center in the medulla. Serotonin (5-hydroxytryptamine), dopamine, histamine, acetylcholine, neurokinin-1, and substance P are among the neurotransmitters that are crucial in causing nausea and vomiting. These pathways may be stimulated by surgical stress, anesthetic medications, opioids, delayed stomach emptying, gastrointestinal irritation, and metabolic disorders, all of which can lead to PONV.

Perioperative intravenous glucose delivery has recently drawn interest as a straightforward, low-cost, and perhaps successful method for lowering PONV. Fluids containing dextrose may affect a number of physiological processes that contribute to postoperative nausea and vomiting. Sufficient glucose availability minimizes protein catabolism, enhances carbohydrate metabolism, suppresses perioperative ketosis, and lessens metabolic stress brought on by fasting and surgery. By improving gastrointestinal motility and stomach emptying, maintaining normal glucose homeostasis may lessen activation of the vagal afferent pathways that cause nausea and vomiting.

Aim: To evaluate the efficacy of perioperative intravenous infusion of 500 mL of 5% dextrose in reducing the incidence and severity of postoperative nausea and vomiting (PONV) in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Objectives Primary Objective • To compare the incidence of postoperative nausea and vomiting within the first 24 hours after laparoscopic cholecystectomy between patients receiving perioperative 5% dextrose infusion and those receiving standard crystalloid solution. Materials and Methods This prospective, randomized, comparative clinical study was conducted to evaluate the effect of perioperative administration of 500 mL of 5% dextrose on postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. The study was carried out in the Department of Anaesthesiology over a period of 06 months. Study Population A total of 60 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were enrolled in the study. Sample Size The study included 60 patients based on previous published literature reporting the incidence of PONV following laparoscopic cholecystectomy and considering feasibility during the study period. Patients were equally allocated into two study groups comprising 30 patients each. • Group D (Dextrose Group): Patients received 500 mL of 5% dextrose intravenously during the perioperative period. • Group C (Control Group): Patients received 500 mL of isotonic crystalloid solution (Ringer's lactate or 0.9% normal saline) during the same period. Inclusion Criteria Patients fulfilling all the following criteria were included: • Age between 18 and 65 years. • Either gender. • American Society of Anesthesiologists (ASA) Physical Status I or II. • Elective laparoscopic cholecystectomy under general anesthesia. • Ability to provide written informed consent. Exclusion Criteria Patients with any of the following conditions were excluded: • Diabetes mellitus. • Uncontrolled hypertension. • Pregnancy or lactation. • Body Mass Index (BMI) >35 kg/m². • History of motion sickness or severe PONV requiring prolonged hospitalization. • Current use of corticosteroids, antiemetics, or psychoactive medications. • Allergy to dextrose-containing solutions. • Conversion of laparoscopic procedure to open cholecystectomy. Preoperative Assessment All patients underwent a detailed pre-anesthetic evaluation one day before surgery. The assessment included: • Detailed medical history. • Physical examination. • Airway assessment. • ASA grading. • Routine laboratory investigations including complete blood count, renal function tests, liver function tests, fasting blood sugar, serum electrolytes, coagulation profile, and electrocardiography where indicated. Patients were instructed to remain nil per oral (NPO) for 6–8 hours before surgery according to institutional fasting guidelines. Anaesthetic Technique All patients received a standardized anesthetic protocol. Premedication included: • Glycopyrrolate 0.2 mg IV • Midazolam 1–2 mg IV • Fentanyl 2 µg/kg IV Anesthesia was induced using: • Propofol 2 mg/kg IV • Vecuronium 0.1 mg/kg IV to facilitate tracheal intubation. Postoperative Assessment Patients were observed in the post-anesthesia care unit (PACU) and subsequently in the surgical ward for 24 hours. Assessment intervals included: • 0–2 hours • 2–6 hours • 6–12 hours • 12–24 hours Statistical Analysis Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) software version 26.0 (IBM Corp.). Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were expressed as frequency and percentage. Comparisons between groups were performed using: • Chi-square test or Fisher's exact test for categorical variables. • Repeated measures ANOVA for serial blood glucose measurements. A p-value <0.05 was considered statistically significant.

Table 1. Baseline Demographic and Clinical Characteristics

No statistically significant difference was observed between groups regarding baseline characteristics (p > 0.05).

Table 2. Incidence of Postoperative Nausea and Vomiting within 24 Hours

Patients receiving 5% dextrose showed a significantly lower incidence of PONV and rescue antiemetic requirement.

Table 3. Comparison of Postoperative Clinical Outcomes

Patients in the dextrose group experienced less severe nausea, fewer vomiting episodes, earlier oral intake, and higher satisfaction.

Table 4. Perioperative Blood Glucose and Adverse Events

One of the most frequent side effects of general anesthesia, especially after laparoscopic surgeries, is postoperative nausea and vomiting (PONV). PONV still affects patient comfort, delays recovery, lengthens stays in the post-anesthesia care unit (PACU), and raises healthcare costs despite the availability of effective antiemetic medications. In order to lessen the frequency and severity of PONV in patients undergoing elective laparoscopic cholecystectomy, the current study assessed the possible role of perioperative administration of 500 mL of 5% dextrose as an adjuvant intervention.

This study's main finding was that preoperative infusion of 500 mL of 5% dextrose was linked to a decreased incidence of postoperative nausea and vomiting within the first 24 hours following surgery. Additionally, compared to patients receiving isotonic crystalloid alone, patients receiving dextrose infusion showed reduced nausea severity scores and fewer episodes of vomiting. These results support the theory that perioperative glucose administration may improve surgical recovery and gastrointestinal function.

Additionally, intravenous glucose may lessen gastric acid output and enhance stomach emptying. Increased plasma glucose has been shown in experiments to reduce stomach irritation by stimulating insulin secretion and modulating vagal activity. Increased stomach motility reduces vagal stimulation and gastric distension, both of which are factors in nausea and vomiting after laparoscopic surgery.

The results of this study are consistent with earlier research assessing intravenous glucose delivery for PONV prophylaxis. Several randomized controlled trials have demonstrated a significant reduction in nausea severity, vomiting episodes, and rescue antiemetic demand following perioperative glucose infusion. Patients undergoing ambulatory surgery and gynecological laparoscopic procedures have also shown comparable advantages.

The study does, however, have certain drawbacks. Because it was only done at one tertiary care facility, the results were not as broadly applicable. Only non-diabetic ASA I–II patients undergoing elective laparoscopic cholecystectomy were included in the very small sample size. As a result, patients with diabetes, older people with serious comorbidities, or patients undergoing other surgical operations might not immediately benefit from the findings. After 24 hours, long-term surgical results were not assessed. To validate these results and ascertain the ideal timing and volume of perioperative glucose administration, more extensive patient groups and higher sample sizes in future multicenter randomized controlled trials are necessary.

Overall, the results lend credence to the idea that administering 500 mL of 5% dextrose perioperatively could be a safe, cost-effective, and useful supplemental method for lessening postoperative nausea and vomiting after laparoscopic cholecystectomy. More research is necessary before including this intervention into multimodal ERAS protocols.

Perioperative administration of 500 mL of 5% dextrose appears to be a simple, safe, and cost-effective adjunct for reducing postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Moderate intravenous glucose supplementation may reduce the incidence and severity of nausea, decrease vomiting episodes, lower the requirement for rescue antiemetic medication, and improve overall patient satisfaction without producing clinically significant hyperglycemia in non-diabetic patients.

Although perioperative dextrose infusion should not replace established antiemetic prophylaxis in high-risk patients, it may provide additional benefit as part of a multimodal strategy for PONV prevention. Further large-scale, multicenter randomized controlled trials are required to establish standardized recommendations regarding the optimal dose, timing, and patient selection for perioperative dextrose administration.

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