Effect of oral ginger on prevention of nausea and vomiting after laparoscopic cholecystectomy
A double-blind, randomized, placebo-controlled trial
Keywords:
Nausea, Vomiting, Postoperative Nausea and Vomiting, Ginger, Cholecystectomy, LaparoscopicAbstract
Background: Postoperative nausea and vomiting (PONV) are among the most frequent complications following laparoscopic cholecystectomy. Recently, some studies have shown ginger, as an herbal medicine, to be effective and safe in PONV prevention; however, there is no evidence of its efficacy in the Iranian population. Objective: The aim of this study was to determine the effect of oral ginger on PONV prevention after laparoscopic cholecystectomy. Methods: This double-blind, randomized, placebo-controlled clinical trial was performed on women who were undergoing laparoscopic cholecystectomy in Imam Raza Hospital, Mashhad, Iran between April and November, 2016. Patients were divided randomly into two groups of G) intervention group (n=75, received 2 capsules containing 250 mg ginger) and P) placebo group (n=75, received 2 placebo capsules) one hour before surgery. Nausea severity and vomiting frequency were evaluated at 2, 4, 6, and 12 hours after the operation. Data analysis was done by SPSS version 16.0 software with Chi-square test, Independent-sample-t-test, repeated measure ANOVA and Mann–Whitney U test. Results: The two groups were homogenous in terms of age, gender and surgery duration. The severity of nausea was lower in the ginger group at the 2, 4, 6, and 12 hours after the operation; however, these differences were statically significant only at 2 (p=0.034) and 12 hours (p=0.043). Although the incidence of vomiting was higher in the placebo group in the 2nd and 12th hours after surgery, the number of vomiting episodes in 2, 4, 6 and 12 hours after surgery was statistically similar in the two groups (p>0.05). The nausea severity was significantly changed during 12 hours of study in both groups (p=0.001), however the nausea severity was always lower in the ginger group (p=0.078). Conclusion: This study demonstrated that 500mg oral ginger one hour before surgery in women who were undergoing laparoscopic cholecystectomy is effective in decreasing severity of PONV. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016122222218N2. Funding: The study was financially supported by Deputy of Research of Mashhad University of Medical Sciences.
References
Cao X, White PF, Ma H. An update on the management of postoperative nausea and vomiting. Journal of
Anesthesia. 2017: 1-10. doi: 10.1007/s00540-017-2363-x.
Karanicolas PJ, Smith SE, Kanbur B, Davies E, Guyatt GH. The impact of prophylactic dexamethasone on
nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis. Annals of
surgery. 2008; 248(5): 751-62. doi: 10.1097/SLA.0b013e3181856024. PMID: 18948802.
Beattie WS, Lindblad T, Buckley DN, Forrest JB. The incidence of postoperative nausea and vomiting in
women undergoing laparoscopy is influenced by the day of menstrual cycle. Can J Anaesth. 1991; 38(3):
-302. doi: 10.1007/BF03007618. PMID: 1828016.
Eberhart LH, Frank S, Lange H, Morin AM, Scherag A, Wulf H, et al. Systematic review on the recurrence
of postoperative nausea and vomiting after a first episode in the recovery room–implications for the
treatment of PONV and related clinical trials. BMC anesthesiology. 2006; 6(1): 14. doi: 10.1186/1471- 2253-6-14. PMID: 17166262, PMCID: PMC1712223.
Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention.
Anesthesiology. 1992; 77(1): 162-84. doi: 10.1097/00000542-199207000-00023.
Gan TJ. Risk factors for postoperative nausea and vomiting. Anesthesia & Analgesia. 2006; 102(6): 1884- 98. doi: 10.1213/01.ANE.0000219597.16143.4D. PMID: 16717343.
Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000; 59(2): 213-43.
doi: 10.2165/00003495-200059020-00005. PMID: 10730546.
Korttila K, Kauste A, Auvinen J. Comparison of domperidone, droperidol, and metoclopramide in the
prevention and treatment of nausea and vomiting after balanced general anesthesia. Anesthesia &
Analgesia. 1979; 58(5): 396-400. doi: 10.1213/00000539-197909000-00010.
Hafizi L, Kiafar M, Shamloo AS, Andalibizadeh S, Nouri M, Zirak N. Comparison of the Efficacy of
Midazolam Vs. Ondansetron in Preventing Post Operative Nausea and Vomiting in Gynecologic
Laparoscopic Surgeries:Double-blinded Randomized Clinical Trial Study. Science Journal of Medicine and
Clinical Trials. 2013; 2013. doi: 10.7237/sjmct/178.
Stott A. Examining the efficacy of stimulating the PC6 wrist acupuncture point for preventing
postoperative nausea and vomiting: A Cochrane review summary. International journal of nursing studies.
; 64: 139-41. doi: 10.1016/j.ijnurstu.2016.07.004. PMID: 27817841.
Marx W, Kiss N, Isenring L. Is ginger beneficial for nausea and vomiting? An update of the literature.
Current opinion in supportive and palliative care. 2015; 9(2): 189-95. doi:
1097/SPC.0000000000000135. PMID: 25872115.
Girard N. Evidence appraisal of Seidi J, Ebnerasooli S, Shahsawari S, Nzarian S. The influence of oral
ginger before operation on nausea and vomiting after cataract surgery under general anesthesia: a double- blind placebo-controlled randomized clinical trial. AORN j. 2017; 105(6): 628-33. DOI:
1016/j.aorn.2017.04.014. PMID: 28554360.
Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional
supplement use and potential product interactions among older adults living on the United States-Mexico
border. Drugs & aging. 2009; 26(5): 423-36. doi: 10.2165/00002512-200926050-00006. PMID: 19552494.
Cohen PA, Ernst E. Safety of herbal supplements: a guide for cardiologists. Cardiovascular therapeutics.
; 28(4): 246-53. doi: 10.1111/j.1755-5922.2010.00193.x. PMID: 20633025.
Singletary K. Ginger: an overview of health benefits. Nutrition Today. 2010; 45(4): 171-83. doi:
1097/NT.0b013e3181ed3543.
Palatty PL, Haniadka R, Valder B, Arora R, Baliga MS. Ginger in the prevention of nausea and vomiting: a
review. Critical reviews in food science and nutrition. 2013; 53(7): 659-69. doi:
1080/10408398.2011.553751. PMID: 23638927.
Haniadka R, Saldanha E, Sunita V, Palatty PL, Fayad R, Baliga MS. A review of the gastroprotective
effects of ginger (Zingiber officinale Roscoe). Food & function. 2013; 4(6): 845-55. doi:
1039/c3fo30337c. PMID: 23612703.
Zick SM, Ruffin MT, Lee J, Normolle DP, Siden R, Alrawi S, et al. Phase II trial of encapsulated ginger as
a treatment for chemotherapy-induced nausea and vomiting. Supportive care in cancer. 2009; 17(5): 563- 72. doi: 10.1007/s00520-008-0528-8. PMID: 19005687, PMCID: PMC4131259.
Thomson M, Corbin R, Leung L. Effects of ginger for nausea and vomiting in early pregnancy: a meta- analysis. The Journal of the American Board of Family Medicine. 2014; 27(1): 115-22. doi:
3122/jabfm.2014.01.130167. PMID: 24390893.
Seidi J, Ebnerasooli S, Shahsawari S, Nzarian S. The Influence of Oral Ginger before Operation on Nausea
and Vomiting after Cataract Surgery under General Anesthesia: A double-blind placebo-controlled
randomized clinical trial. Electron physician. 2017; 9(1): 3508-14. doi: 10.19082/3508. PMID: 28243400,
PMCID: PMC5308488.
Eberhart LH, Mayer R, Betz O, Tsolakidis S, Hilpert W, Morin AM, et al. Ginger does not prevent
postoperative nausea and vomiting after laparoscopic surgery. Anesthesia and analgesia. 2003; 96(4): 995- 8. doi: 10.1213/01.ANE.0000055818.64084.41. PMID: 12651648.
Burroughs VJ, Maxey RW, Levy RA. Racial and ethnic differences in response to medicines: towards
individualized pharmaceutical treatment. Journal of the National Medical Association. 2002; 94(10 Suppl):
PMID: 12401060, PMCID: PMC2594139.
Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern
Complement Med. 2009; 15(3): 243-6. doi: 10.1089/acm.2008.0406. PMID: 19250006.
Soltani E, Jangjoo A, Aghaei MA, Dalili A. Effects of preoperative administration of ginger (Zingiber
officinale Roscoe) on postoperative nausea and vomiting after laparoscopic cholecystectomy. Journal of
Traditional and Complementary Medicine. 2017. doi: 10.1016/j.jtcme.2017.06.008.
Hosseini FS, Adib-Hajbaghery M. Ginger essence effect on nausea and vomiting after open and
laparoscopic nephrectomies. Nursing and midwifery studies. 2015; 4(2). doi: 10.17795/nmsjournal28625.
PMID: 26339671, PMCID: PMC4557412.
Adib-Hajbaghery M, Hosseini FS. Investigating the effects of inhaling ginger essence on post-nephrectomy
nausea and vomiting. Complementary therapies in medicine. 2015; 23(6): 827-31. doi:
1016/j.ctim.2015.10.002. PMID: 26645524.
Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of
ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. American journal of
obstetrics and gynecology. 2006; 194(1): 95-9. doi: 10.1016/j.ajog.2005.06.046. PMID: 16389016.
Khalaj AR, Miri SR, Porlashkari M, Mohammadi A. Prophylactic Anti-Emetic Effect of Dexamethasone
and Metoclopramide on the Nausea and Vomiting Induced by Laparoscopic Cholecystectomy: A
Randomized, Double Blind, Placebo-Controlled Trial. Journal of Minimally Invasive Surgical Sciences.
; 2(3): 18-22.
Nesek-Adam V, Grizelj-Stojčić E, Rašić Ž, Čala Z, Mršić V, Smiljanić A. Comparison of dexamethasone,
metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after
laparoscopic cholecystectomy. Surgical endoscopy. 2007; 21(4): 607-12. doi: 10.1007/s00464-006-9122-7.
PMID: 17285386.
Ali BH, Blunden G, Tanira MO, Nemmar A. Some phytochemical, pharmacological and toxicological
properties of ginger (Zingiber officinale Roscoe): a review of recent research. Food and chemical
Toxicology. 2008; 46(2): 409-20. doi: 10.1016/j.fct.2007.09.085. PMID: 17950516.
Mandal P, Das A, Majumdar S, Bhattacharyya T, Mitra T, Kundu R. The efficacy of ginger added to
ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery. Pharmacognosy
research. 2014; 6(1): 52. doi: 10.4103/0974-8490.122918. PMID: 24497743, PMCID: PMC3897009.
Morin A, Betz O, Kranke P, Geldner G, Wulf H, Eberhart L. Is ginger a relevant antiemetic for
postoperative nausea and vomiting? Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie:
AINS. 2004; 39(5): 281-5. PMID: 15156419.
Care AI. A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea
and vomiting. Anaesthesia and intensive care. 1995; 23(4).
Eberhart LH, Mayer R, Betz O, Tsolakidis S, Hilpert W, Morin AM, et al. Ginger does not prevent
postoperative nausea and vomiting after laparoscopic surgery. Anesthesia & Analgesia. 2003; 96(4): 995-8.
doi: 10.1213/01.ANE.0000055818.64084.41.
Montazeri AS, Raei M, Hamidzadeh A, Hamzekhani M, Soozani A, Kalatejari M, et al. Evaluation the
effect of ginger on postoperative nausea and vomiting. Danesh and Tandorosti Journal. 2012; 7(3): 118-23.
Nanthakomon T, Pongrojpaw D. The efficacy of ginger in prevention of postoperative nausea and vomiting
after major gynecologic surgery. J Med Assoc Thai. 2006; 89(Suppl 4): S130-6. PMID: 17725149.
Kalava A, Darji SJ, Kalstein A, Yarmush JM, Schianodi Cola J, Weinberg J. Efficacy of ginger on
intraoperative and postoperative nausea and vomiting in elective cesarean section patients. Eur J Obstet
Gynecol Reprod Biol. 2013; 169(2): 184-8. doi: 10.1016/j.ejogrb.2013.02.014. PMID: 23510951.
Apariman S, Ratchanon S, Wiriyasirivej B. Effectiveness of ginger for prevention of nausea and vomiting
after gynecological laparoscopy. Journal-Medical Association of Thailand. 2006; 89(12): 2003. PMID:
Arfeen Z, Owen H, Plummer JL, Ilsley AH, Sorby-Adams RA, Doecke CJ. A double-blind randomized
controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesthesia and
intensive care. 1995; 23(4): 449-52. PMID: 7485935.
Lee YR, Shin HS. Effectiveness of Ginger Essential Oil on Postoperative Nausea and Vomiting in
Abdominal Surgery Patients. The Journal of Alternative and Complementary Medicine. 2017; 23(3): 196- 200. doi: 10.1089/acm.2015.0328. PMID: 27841938.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.