Review: ginger prevents 24 hour postoperative nausea and vomiting
Q Is ginger (Zingiber officinale) better than placebo for preventing 24 hour postoperative nausea and vomiting?
Medline, International Pharmaceutical Abstracts, CINAHL, Cochrane Central, HealthStar, Current Contents, bibliographies of relevant articles, pharmaceutical companies, authors, and experts in the field.
Study selection and assessment:
published and unpublished randomised controlled trials (RCTs) that compared the antiemetic effects of ⩾1 g of ginger with placebo for preventing postoperative nausea and vomiting and included sufficient data to calculate the incidence of 24 hour postoperative nausea and vomiting or postoperative vomiting. 5 RCTs (n = 363) met the selection criteria (age range 31–46 y, primarily gynaecological surgery). All included RCTs had Jadad quality scores of 3 or 4 out of 5.
postoperative vomiting, postoperative nausea and vomiting, and adverse effects.
Meta-analysis using a random effects model showed that patients who received ginger before induction of anaesthesia (4 RCTs, n = 308) or before and after surgery (1 RCT, n = 55) had a lower incidence of postoperative vomiting and a lower incidence of postoperative nausea and vomiting than those who received placebo (table). In 1 RCT (n = 80), 1 patient reported abdominal discomfort.
Ginger is better than placebo for preventing 24 hour postoperative nausea and vomiting.
Postoperative nausea and vomiting is an important problem that may lead to postoperative complications, increased care costs, and patient dissatisfaction. Most patients included in the meta-analysis by Chaiyakunapruk et al were Asian, and mean patient weight was 50 kg. Thus, the findings may not be completely generalisable, although one third of patients weighed >60 kg. Also of note is that a minimal amount of anaesthesia was used. Obesity and the amount and duration of anaesthesia are risk factors for postoperative nausea and vomiting1 and should be considered.
The findings of the meta-analysis are relevant to perioperative nurses. Because most patients had gynaecological and laparoscopic procedures, the review is particularly relevant to nurses working with these types of patients. The findings increase our knowledge of a complementary and alternative treatment that is promoted widely but has undergone little systematic study.
Although nurses have advocated ginger containing products (eg, ginger ale, teas, and candied ginger) for treatment of nausea and vomiting, prevention of this distressing and costly sequela would be optimal. For advanced practice nurses with prescribing privileges, the findings are an important consideration in the management of patients who have risk factors for postoperative vomiting or postoperative nausea and vomiting, as ⩾1 g of ginger administered preoperatively may prevent its development. Additionally, this knowledge is useful for bedside nurses because the dose of ginger in the previously mentioned products is well below the therapeutic dose (ie, 1 g) used in the studies included in the meta-analysis. In most studies, ginger root powder was administered in capsule form, which is likely to be more acceptable and palatable to patients than the powder form.
For correspondence: Dr N Chaiyakunapruk, School of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Source of funding: Thailand Research Fund.