Nasogastric Tube Decompression for Postoperative Nausea

Overseen By Katherine A Curry, DDS

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Nova Scotia Health Authority

Must not be taking: GLP-1 receptor agonists

Disqualifiers: Under 16, Pregnant, Gastroparesis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

92 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to reduce nausea and vomiting after jaw surgery by comparing two methods: using a nasogastric (NG) tube to clear the stomach and not using one (no NG tube gastric decompression). The goal is to determine if skipping the NG tube aids in nausea relief within the first 24 hours post-surgery. Participants undergoing jaw surgery to correct facial deformities are sought, provided they have not experienced issues like delayed stomach emptying before. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance post-surgical care.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but if you are taking GLP-1 receptor agonists, you cannot participate.

What prior data suggests that nasogastric tube decompression is safe for postoperative nausea management?

Research shows that patients can safely skip using a nasogastric (NG) tube after surgery. Some studies suggest that recovery might be faster without one. Although NG tubes are generally safe, they can cause discomfort, such as a sore throat or nausea. Avoiding an NG tube might help prevent these side effects. Overall, patients appear to manage well without an NG tube. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about nasogastric (NG) tube decompression trials for postoperative nausea because they aim to see if avoiding this standard treatment can reduce discomfort and improve recovery. Traditionally, NG tubes are used to drain stomach contents after surgery, which can be quite uncomfortable for patients. The innovative approach is to skip the NG tube altogether, potentially offering a more comfortable recovery by relying on the body's natural processes instead. By comparing this method to the conventional use of NG tubes, researchers hope to find out if patients can experience less discomfort and still effectively manage nausea after surgery.

What evidence suggests that nasogastric tube decompression is effective for reducing postoperative nausea?

Research has shown that using a nasogastric (NG) tube, inserted through the nose into the stomach, after major surgery does not significantly reduce nausea or vomiting. Studies have found that routinely using NG tubes neither speeds up bowel recovery nor reduces post-surgery nausea. Additionally, the NG tube can cause a sore throat or other discomforts. In this trial, one group of participants will not have an NG tube inserted, potentially avoiding these side effects. Overall, skipping the NG tube after surgery may not increase nausea and could enhance comfort. ^{1 2 4 6 7}

Who Is on the Research Team?

James Brady, DDS/MD

Principal Investigator

NSHA

Are You a Good Fit for This Trial?

This trial is for patients over 16 years old undergoing corrective jaw surgery (orthognathic surgery) at Victoria General Hospital. It includes those having double-jaw or single-jaw surgeries, and those getting a functional genioplasty with another osteotomy.

Inclusion Criteria

I am undergoing surgery on both jaws.

I am over 16 and having surgery to correct a jaw or facial deformity.

I am planning to have jaw surgery.

Exclusion Criteria

I am younger than 16 years old.

I am currently taking GLP-1 receptor agonists.

I am having a surgery to change the shape of my chin.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo orthognathic surgery with or without nasogastric tube gastric decompression

1 day

1 visit (in-person)

Postoperative Monitoring

Participants are monitored for early and delayed postoperative nausea and vomiting (PONV) within the first 24 hours after surgery

24 hours

Continuous monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• No NG tube gastric decompression

Trial Overview The study compares the occurrence of nausea and vomiting within the first day after orthognathic surgery between patients who have nasogastric tube gastric decompression and those who do not.

How Is the Trial Designed?

Group I: No NG Gastric Decompression Experimental Treatment 1 Intervention

No NG tube gastric decompression for orthognathic surgery. This group will not have a NG tube inserted. The remainder of their surgical care will be identical to the other group. PONV will be evaluated by nursing and surgical team at two time points in the 24 hour postoperative period (early \[0-2 hours\] and delayed \[2-24 hours\]).

Group II: NG Gastric Decompression Active Control 1 Intervention

Participants will undergo NG tube gastric decompression according to our institution's typical gastric decompression regimen. Once patients are anesthetized and intubated, and a #14 French NG tube will be inserted in the naris opposite the nasotracheal tube and hooked up to low suction to confirm placement. If in the correct position, gastric contents will be seen in suction tubing. If no gastric contents are seen, the NG tube will be adjusted accordingly. The NG tube will be connected to suction until all stomach contents are effectively removed, as demonstrated by no new secretions in the suction tubing. It will then be disconnected from suction, secured with tape throughout surgery and temporarily hooked back up to suction at the end of surgery to reconfirm position and suction stomach contents present. The NG tube will then be secured and left in place for one hour on intermittent suction following arrival to the recovery unit. After one hour, the NG tube will be removed.

Who Is Running the Clinical Trial?

Nova Scotia Health Authority

Lead Sponsor

Trials

302

Recruited

95,300+

Published Research Related to This Trial

In a randomized trial of 197 patients, postoperative nasogastric tube decompression did not significantly reduce complications or improve recovery compared to no decompression, with only two patients needing decompression in the non-decompression group.

Patients who received nasogastric decompression experienced significantly more sore throat and nausea, suggesting that routine use of this procedure after elective abdominal surgery may not be justified and should be limited to cases with specific complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nasogastric suction after elective abdominal surgery: a randomised study. Nathan, BN., Pain, JA.[2022]

In a study of 40 patients undergoing infrarenal aortic surgery, early removal of nasogastric tubes (NGTs) at the time of tracheal extubation did not significantly reduce nausea and vomiting compared to keeping the NGT until the passage of flatus.

However, maintaining the NGT was associated with a higher risk of respiratory complications and a longer hospital stay, suggesting that early NGT removal may be safer and more efficient for recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence for early nasogastric tube removal after infrarenal aortic surgery: a randomized trial. Gouëffic, Y., Rozec, B., Sonnard, A., et al.[2012]

In a study of 535 patients undergoing elective colorectal surgery, routine nasogastric (NG) decompression significantly reduced symptoms like abdominal distention, nausea, and vomiting compared to those who did not receive decompression.

Despite these benefits, there were no significant differences in major complications or length of hospital stay between the two groups, leading to the conclusion that routine NG decompression may not be necessary after such surgeries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. Wolff, BG., Pembeton, JH., van Heerden, JA., et al.[2019]

In a study of 109 patients undergoing gastrointestinal surgery, the use of nasogastric tubes did not significantly affect recovery outcomes such as hospitalization duration or time to start oral fluid intake.

However, patients with nasogastric tubes experienced more complications like abdominal distension and dysphagia, suggesting that routine use of these tubes after surgery may not be necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study. Savassi-Rocha, PR., Conceicão, SA., Ferreira, JT., et al.[2009]

In a study of 210 patients undergoing elective hepatectomy, routine nasogastric tube (NGT) decompression did not show any significant benefits over not using an NGT, as both groups had similar rates of complications and recovery times.

The use of NGT was associated with some discomfort in patients, but overall, it did not reduce postoperative nausea, vomiting, or hospital stay duration, suggesting that routine NGT decompression may not be necessary after this type of surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial for Evaluation of the Routine Use of Nasogastric Tube Decompression After Elective Liver Surgery. Ichida, H., Imamura, H., Yoshimoto, J., et al.[2018]

In a study of 174 gastric cancer patients, those with a nasogastric decompression tube experienced significantly lower rates of postoperative symptoms like nausea and sore throat compared to those without the tube.

However, patients without the nasogastric tube had quicker recovery times for ambulation and flatus, suggesting that early removal of the tube is safe and can enhance the quality of life during hospitalization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Value of nasogastric decompression tube in patients with gastric cancer]. Yu, XF., Wei, YZ., Xue, YW.[2012]

In a study of 100 patients undergoing infrarenal aortic surgery, those with routine nasogastric tube (NGT) placement experienced significantly higher rates of postoperative nausea and vomiting (PONV) compared to those with selective NGT use (48% vs. 10%).

Selective use of NGT was associated with quicker resumption of oral intake within the first 48 hours post-surgery, suggesting that routine NGT placement may not provide benefits and could lead to more complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic nasogastric tube in aortic surgery: is it necessary? Hernández Mateo, MM., Martínez-López, I., Hernando-Rydings, M., et al.[2015]

In a follow-up study of 480 patients who underwent elective abdominal colorectal surgery, those who did not receive nasogastric (NG) decompression had a higher rate of abdominal distention, nausea, and vomiting, but this did not lead to a significantly increased incidence of incisional hernias (6.6% vs. 3.2%).

The findings support the conclusion that routine postoperative NG decompression is not necessary for uncomplicated cases, as it does not prevent hernia formation despite reducing postoperative discomfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial. Otchy, DP., Wolff, BG., van Heerden, JA., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2151862/

Routine postoperative use of the nasogastric tube – utility or ... Routine gastric decompression after major surgery neither hastens the return of bowel function nor diminishes the incidence of postoperative nausea and vomiting ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT00193999

Do Nasogastric Tubes After Cardiac Surgery Reduce ... Gastric emptying is delayed after cardiac surgery, but the efficacy of the nasogastric (NG) tube in preventing distension and reducing vomiting is unclear.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1053077010000364

The Effect of Nasogastric Tube Application During Cardiac ... The purpose of this study was to determine if application of a nasogastric (NG) tube during cardiac surgery can reduce the prevalence of postoperative PONV.

4. mdpi.com mdpi.com/2077-0383/14/19/6901

Evidence-Based Perioperative Prevention of Postoperative ... Impact of routine nasogastric decompression versus no nasogastric decompression after pancreaticoduodenectomy on perioperative outcomes: Meta-analysis. BJS ...

5. withpower.com withpower.com/trial/phase-nausea-6-2024-d139f

Nasogastric Tube Decompression for Postoperative Nausea Nasogastric tube decompression is generally safe, but it can cause side effects like sore throat, nausea, and other discomforts.

6. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK556063/

Nasogastric Tube - StatPearls - NCBI Bookshelf - NIH Patients who develop postoperative ileus tend to recover faster without the placement of an NG tube.[6]. Less commonly, nasogastric tubes can ...

7. centerwatch.com centerwatch.com/clinical-trials/listings/NCT06422793/the-impact-of-nasogastric-tube-gastric-decompression-on-postoperative-nausea-and-vomiting-in-orthognathic-surgery

The Impact of Nasogastric Tube Gastric Decompression on ... This study will compare the incidence of postoperative nausea and vomiting during the first 24 hours following corrective jaw surgery (orthognathic surgery)