Post-operative distress is usually reported in pediatric patients because of multiple factors like thirst, hunger, pain, post-operative vomiting and emergence delirium. 

Pediatric patients <6 years cause trouble differentiating between these causes leading to inappropriate treatment, including administration of opioids, which can increase the incidence of postoperative nausea and vomiting (PONV).

A randomized controlled study assessed the early post-operative liberal oral fluid intake on the incidence of post-operative distress and PONV in children undergoing surgery under general anesthesia. The primary objective of the study was to assess the role of early oral fluid intake after surgery on PONV in children.

The study enrolled 200 pediatric patients aged between 1–6 years posted for elective infraumbilical extraperitoneal surgery. Pediatric patients with known digestive pathology (hiatal hernia and gastro-esophageal reflux) and predisposition to PONV were excluded.

All subjects received standardized anesthesia and were scored by post-operative vomiting in children risk (POVOC) score (strabismus surgery [0–1], age ≥3 years[0–1], duration of surgery >30 min[0–1], history of POV-[0–1]), before reversal. Subjects with post-operative vomiting in children risk score ≥3 were rendered antiemetic prophylaxis with dexamethasone 0.15mg/kg.

Following surgery, all patients were transferred to the post-anesthesia care unit (PACU), where they were randomized to either the Control group (CG) or the Liberal group (LG).

The patients were subjected to Face Legs Activity Cry Consolability score (FLACC) score calculation every 15 min until they were shifted to the ward. Patients in LG with a FLACC ≥4 were administered 10mL/kg of 10% D/W. post-operative i.v. analgesic protocol was applied if the FLACC score remained ≥4, after consuming the fluid. Children within the LG were never forced to consume liquid. 

While the patients in CG with a FLACC score ≥4 got morphine 0.05 mg/kg and drinking was allowed after returning to the ward. Paracetamol 15 mg/kg IV was rendered 8-hourly in both groups. ondansetron 0.15 mg/kg was given upon the second episode of POV or at the parent′s request.

The observations were as follows-

• 92 children in LG and 95 children in CG were enrolled
• No significant differences were present between the 2 groups, regarding patient characteristics, surgical procedure and anaesthesia data.
• Both groups showed similar POVOC scores and FLACC scores in PACU.
• The episode of POV was 10.87% in LG which was significantly less than POV in CG, 23.16%.
• 13.04% of patients within the LG and 35.79% of patients within the CG needed opioid analgesic,  
• The total dose of opioid used per patient was 0.070 mg/kg in LG and 0.093 mg/kg per patient within the CG
• The mean PACU stay was shorter as 65.82 min in LG than 77.16 min in CG.
• Signs of agitation or emergence delirium in PACU were not significantly different between the two groups
• No complications were noted associated with early oral intake.    

Thus it was concluded that early post-operative oral fluid if offered to children between 1–6 years of age with FLACC scores ≥4 before administration of opioids, helps in reducing the utilization and dose of opioid administration without increasing any significant adverse events and it also decreases the incidence of POV and PACU stay without increasing any adverse events.

Source: Indian J Anaesth [serial online] 2020 [cited 2021 Aug 5];64:979-81. Available from: https://www.ijaweb.org/text.asp?2020/64/11/979/299684