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

Trial Summary

What is the purpose of this trial?

This study will compare the incidence of postoperative nausea and vomiting during the first 24 hours following corrective jaw surgery (orthognathic surgery) in patients with and without nasogastric tube gastric decompression.

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 data supports the effectiveness of the treatment No NG tube gastric decompression for postoperative nausea?

Research shows that not using a nasogastric tube after surgery does not increase complications like vomiting or delay recovery, and it may reduce sore throat and nausea compared to using the tube. ^{1 2 3 4 5}

Is nasogastric tube decompression generally safe for humans?

Nasogastric tube decompression is generally safe, but it can cause side effects like sore throat, nausea, and other discomforts. Studies suggest that routine use may not be necessary and can lead to more complications compared to not using the tube. ^{1 4 5 6 7}

How does the treatment of no nasogastric tube decompression differ from other treatments for postoperative nausea?

The treatment of no nasogastric tube decompression after surgery is unique because it avoids the routine use of a tube to remove stomach contents, which can lead to fewer complications like sore throat and nausea compared to using the tube. Studies suggest that not using the tube does not significantly affect recovery time or complication rates, making it a viable option for many patients. ^{1 2 3 4 8}

Research Team

James Brady, DDS/MD

Principal Investigator

NSHA

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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 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 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]

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 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 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]

References

1. England pubmed.ncbi.nlm.nih.gov

Nasogastric suction after elective abdominal surgery: a randomised study. [2022]

2. China pubmed.ncbi.nlm.nih.gov

[Value of nasogastric decompression tube in patients with gastric cancer]. [2012]

3. United States pubmed.ncbi.nlm.nih.gov

Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study. [2009]

5. United States 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. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Evidence for early nasogastric tube removal after infrarenal aortic surgery: a randomized trial. [2012]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Systematic nasogastric tube in aortic surgery: is it necessary? [2015]

8. United States pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial for Evaluation of the Routine Use of Nasogastric Tube Decompression After Elective Liver Surgery. [2018]