Pre-Op Carbohydrate Drink vs IV Dextrose/Insulin for PONV in Type 2 Diabetes Patients Undergoing TKA .
Preoperative Carbohydrate Drinks Do Not Decrease Postoperative Nausea and Vomiting in Type 2 Diabetic Patients Undergoing Total Knee Arthroplasty-A Randomized Controlled Trial
J Am Acad Orthop Surg. 2021 Jan 1;29(1): 35-43.Eighty-two patients with Type 2 diabetes scheduled to undergo a unilateral or bilateral total knee arthroplasty (TKA) were randomized to receive an oral drink of carbohydrates (n=41) before surgery or intravenous (IV) dextrose infusion mixed with insulin (n=41) to reduce post-operative nausea and vomiting (PONV). Main outcomes of interest included PONV, quality of recovery (QoR) measured using QoR-40 (i.e., physical comfort, emotional state, physical independence, psychological support, pain) at 24-hours post-TKA, blood glucose levels, incidence of antiemetic use, and length of hospital stay. PONV was recorded at 0-12 hours, 12-24 hours, and 24-36 hours post-operation. Study results demonstrated that across all timepoints and groups, no significant difference was observed for PONV between the two groups (p=0.795). Median global QoR scores in the carbohydrate group was significantly better compared to the IV dextrose group (median of 160 vs median 155; p=0.009). No significant differences in the incidence of anti-emetic use or length of hospital stay were observed between the two groups (p>0.05 for both).
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