The Effect of Oral Honey and Water Up to Two Hours Before Surgery on Postoperative Nausea and Vomiting
The Effect of Oral Honey and Water Up to Two Hours Before Surgery on Postoperative Nausea and Vomiting
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.
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.
Inclusion Criteria

 -  Individuals who volunteered to participate in the study

 -  Individuals who have the ability to make decisions

 -  Thyroidectomy operation

 -  Laparoscopic cholecystectomy (Lap. Chol.) operation

 -  Individuals who score 2/5 or more out of the Koivuranta PONV risk factors*

 Exclusion Criteria

 -  Patients with diabetes,

 -  Nothing by mouth patients (for other reasons than surgery),

 -  Gastrointestinal system surgery patients

 -  Individuals with pollen allergy

 -  Koivuranta PONV risk factors:

 Female gender, Non-smoking individuals History of PONV History of motion sickness
 Anesthesia duration