Can Preoperative Carbohydrate Drinks and Multimodal Analgesia Reduce Nausea, Vomiting, and Pain After Total Knee Arthroplasty?

Abstract

Postoperative nausea and vomiting (PONV) and pain are major concerns for surgical patients. Preoperative carbohydrate drinks and multimodal analgesia have been proposed as effective methods for many types of surgeries and are included in the enhanced recovery after surgery guidelines. However, as total knee arthroplasty (TKA) surgery does not involve the digestive organs and commonly uses local infiltration analgesia for pain control, do these two interventions still help reduce PONV and pain after joint arthroplasty surgery? This retrospective cohort study evaluated the impact of preoperative carbohydrate drinks and multimodal analgesia on patients undergoing TKA. Data were collected from patient records from June 2022 to April 2024, including 895 patients. Primary outcomes were PONV rates, whereas secondary outcomes encompassed other short-term postoperative measures (length of hospital stay, numeric rating scale pain score, and postoperative day one range of motion) and adverse events (infection or 30-day readmission rates). Data analyses included independent t-tests for numerical data and Chi-square tests for categorical data. We used stratified and sensitivity analyses to address the potential impact of baseline demographic differences between the groups. Preoperative carbohydrate drinks and multimodal analgesia, compared with the control group, did not have a significant effect on PONV. However, we found that the treatment effect varied with body mass index, showing a significant reduction in PONV in patients who have a body mass index ≥ 30. Among secondary outcomes, the intervention significantly reduced pain scores, improved postoperative day one range of motion, and shortened the length of hospital stay. Although the combination of preoperative carbohydrate drinks and multimodal analgesia did not show broad effectiveness in reducing PONV after TKA, it offered significant benefits for obese patients by reducing insulin resistance and decreasing PONV. In addition, it demonstrated notable effectiveness in pain control, which significantly shortened the length of hospital stay.