IV Dextrose to Reduce Postoperative Nausea

Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Postoperative nausea and vomiting (PONV) is a frequent complication of anesthesia and surgery and can interfere with oral intake, delay recovery, and increase the need for rescue medications. Prevention typically relies on a multimodal approach that combines risk-reduction strategies with antiemetic medications such as ondansetron and dexamethasone, often using more than one agent in patients at higher risk. Perioperative intravenous (IV) dextrose has been studied as a possible adjunct to further reduce postoperative nausea. Unlike conventional antiemetics, dextrose does not directly block emetic pathways. Instead, its proposed benefit is related to the metabolic effects of fasting and surgical stress (1).  

Surgery and preoperative fasting place the body under metabolic stress. In response, counterregulatory hormones increase hepatic glucose production while tissues become temporarily less sensitive to insulin. IV dextrose provides an exogenous carbohydrate source, which stimulates insulin secretion and can suppress lipolysis and ketone production. The proposed benefit is therefore not simply an increase in blood glucose, but a reduction in fasting-related catabolism and metabolic instability (2). Dextrose may also influence gastric activity and autonomic signaling, both of which are involved in nausea. Its proposed antiemetic effect is therefore indirect, and the exact mechanism remains uncertain. 

Clinical evidence has been inconsistent. A meta-analysis by Zorrilla-Vaca et al. found that perioperative dextrose did not significantly reduce the overall incidence of PONV in the postanesthesia care unit or during the first 24 hours after surgery. However, patients who received dextrose were less likely to require rescue antiemetic medication (3). Although this does not establish that symptoms were less severe, it raises the possibility that IV dextrose may lessen the intensity or persistence of postoperative nausea even when it does not prevent its occurrence. A separate systematic review and meta-analysis by Yokoyama et al. found reductions in early and late postoperative nausea but no significant reduction in vomiting (4). Together, these findings suggest that dextrose may influence the clinical burden of PONV more than its overall incidence, with potential effects on nausea severity and the need for additional treatment rather than on vomiting itself. 

Some trials have reported greater benefit in specific surgical populations. Firouzian et al evaluated women undergoing laparoscopic cholecystectomy and found that 500 mL of a 5% dextrose-containing solution given before induction was associated with fewer postoperative vomiting events and lower symptom scores (5). This suggests that dextrose may be useful in selected settings, but it does not establish a universal treatment effect. Any benefit may depend on clinical context, including the type of surgery, baseline PONV risk, fasting duration, and the timing and dose of dextrose administration. 

IV dextrose is inexpensive, widely available, and easy to incorporate into perioperative fluid therapy if research continues to demonstrate benefits on postoperative nausea. However, its effects also depend on the patient’s metabolic state. Because surgical stress can reduce insulin sensitivity and impair glucose disposal, additional dextrose may produce excessive hyperglycemia in some patients, particularly those with diabetes or impaired glucose regulation (2). Excessive hyperglycemia may also adversely affect gastric emptying and complicate perioperative management. IV dextrose is therefore best viewed as a possible adjunct rather than a replacement for established multimodal PONV prophylaxis. Further studies are needed to identify patients most likely to benefit and to determine optimal dosing, timing, and monitoring strategies. 

References 

1. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-448. doi:10.1213/ANE.0000000000004833 

2. Schricker T, Lattermann R, Wykes L, Carli F. Effect of i.v. dextrose administration on glucose metabolism during surgery. JPEN J Parenter Enteral Nutr. 2004;28(3):149-153. doi:10.1177/0148607104028003149 

3. Zorrilla-Vaca A, Marmolejo-Posso D, Stone A, Li J, Grant MC. Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials. Anesth Analg. 2019;129(4):943-950. doi:10.1213/ANE.0000000000004019 

4. Yokoyama C, Mihara T, Kashiwagi S, Koga M, Goto T. Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis. PLoS One. 2020;15(4):e0231958. Published 2020 Apr 20. doi:10.1371/journal.pone.0231958 

5. Firouzian A, Kiasari AZ, Godazandeh G, et al. The effect of intravenous dextrose administration for prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy: A double-blind, randomised controlled trial. Indian J Anaesth. 2017;61(10):803-810. doi:10.4103/ija.IJA_420_16