Ice pops in the recovery room: effects on postoperative nausea and vomiting

Editor—Postoperative nausea and vomiting (PONV) is common in all age groups¹ and can have a significant negative impact on patient comfort and recovery after surgery.² Recent guidelines describe pharmacological options for prophylaxis and treatment of PONV, but non-pharmacological options are rarely explored.^2,3 We investigated the effects of ice pops on PONV after elective major orthopaedic joint replacement surgery. Our hypothesis was that an ice pop during the immediate postoperative time period in the recovery room reduces the incidence of PONV.

We retrospectively studied the medical records of a random sample of all 1668 patients >18 yr of age who underwent elective joint replacement surgery in 3 months before and after introduction of the ice pop in the recovery room at Meander Medical Centre (Amersfoort, The Netherlands). Patients with tracheostomies, intubated patients, and patients who were unconscious in the 24 h postoperative were excluded. In total, 96 patients (44 males, mean age 58 yr) in the pre-ice pop period and 97 patients (38 males, mean age 58 yr) in the ice pop period were evaluated. Data on administration of opioids and anti-emetic drugs during surgery and on the wards in the first 24 h after the operation were collected. All patients operated in 2015 were considered treated with an ice pop and those operated in 2014 untreated. We calculated odds ratios with 95% confidence intervals (CIs) for PONV and anti-emetic use with ice pops as the determinant. Other potential determinants of nausea were studied where available and the association corrected for those that confounded the association. Odds ratios and asymptotic 95% CIs were calculated from contingency tables. Correction for confounders was done using logistic regression analysis.

Characteristics of the patients are shown in Table 1. After introduction of ice pops, both PONV and use of anti-emetic drugs occurred less frequently and were less severe. Most potential determinants of both PONV and the use of anti-emetics were more frequent after the introduction of ice pops than before. Adjustment for age, sex, smoking, use of opioids, and a long duration of the operation resulted in an odds ratio of 0.26 (95% CI 0.1–1.0, borderline significance) for PONV. The odds ratio for use of anti-emetics was 0.26 (95% CI 0.1–0.9). We evaluated the effect of ice pops separately among those with opioids because PONV occurred mainly among these patients. Ice pops had an odds ratio for PONV of 0.27 (95% CI 0.09–0.78) and for use of anti-emetics of 0.33 (95% CI 0.1–0.9). In the multivariate analyses, adjusting for age, sex, smoking, duration of the operation, and use of opioids reduced the odds ratio to 0.24 for PONV (95% CI 0.08–0.76) and 0.24 for anti-emetics (95% CI 0.08–0.69).

Table 1

Characteristics of patients with and without ice pop offered after surgery

Patient characteristics	Without ice pop	With ice pop	P-value
n	96	97
Age (yr); mean (sd)	58.3 (17.5)	57.5 (19.6)	0.78
Median [minimum–maximum]	60 [18–99]	60 [18–88]
Male sex [n (%)]	44 (45.8)	38 (39.2)	0.38
Smoking [n (%)]	13 (13.5)	16 (16.5)	0.69
Type of orthopaedic operation [n (%)]			0.05
Knee	42 (43.8)	46 (47.4)
Hip	23 (24.0)	19 (19.6)
Shoulder	9 (9.4)	20 (20.6)
Other elective	22 (22.9)	12 (12.4)
Duration of operation [min; mean (sd)]	39.9 (29.0)	54.1 (45.4)	0.01
Duration >60 min [n (%)]	27 (28.1)	46 (47.4)	0.007
Opioid use [n (%)]	62 (64.6)	69 (71.1)	0.36
Postoperative nausea and vomiting [n (%)]	14 (14.4)	7 (7.1)	0.11
None [n (%)]	82 (85.4)	90 (92.8)	|
Nausea only [n (%)]	5 (5.2)	5 (5.2)	| 0.03
Vomiting only [n (%)]	3 (3.1)	2 (2.1)	|
Both [n (%)]	6 (6.3)	0 (0)	|
Anti-emetic drugs [n (%)]	16 (16.7)	9 (9.3)	0.14

This simple single-centre retrospective study showed that the occurrence of PONV and use of anti-emetics were more than halved after introduction of ice pops in a homogeneous population of elective orthopaedic patients undergoing major joint replacement surgery. The effect was evident only in patients who had received morphine for postoperative analgesia. In those who did not receive morphine, the occurrence of nausea, vomiting, and anti-emetic administration was negligible and did not change with the introduction of ice pops.

For patients at high risk for PONV, use of ice pops provides a cheap, non-invasive, and easy-to-use intervention that appears effective in reducing PONV, notably in patients treated with opioids.

Declaration of interest

None declared.