Efficacy and Risks of Dextrose Infusion to Prevent Postoperative Nausea: a Narrative Review

Postoperative nausea and vomiting (PONV) is a common complication of surgery that prolongs recovery, reduces patient satisfaction, and increases healthcare costs. Traditional pharmacologic treatment with 5-HT₃ receptor antagonists and dopamine antagonists is effective but may be contraindicated or insufficient in some patients with certain comorbidities. The US Food and Drug Administration (FDA) has previously stated that electrical activity of the heart may be effected by 5-HT₃ receptor antagonists which may pre-dispose patients to the potentially fatal arrhythmia torsades de pointes. Perioperative intravenous dextrose infusion has emerged as a non-pharmacologic strategy to prevent PONV by maintaining normal glucose levels, suppressing ketogenesis, and stabilizing metabolic and autonomic stress responses associated with fasting and surgical trauma. Dextrose elevates plasma glucose, stimulates insulin secretion, reduces endogenous glucose production, and may modulate vagal-mediated gastric activity, thereby reducing postoperative nausea and vomiting. Clinical evidence indicated by meta-analyses and randomized trials suggests that dextrose may decrease nausea and reduce the need for rescue antiemetics; however, its effect on vomiting is inconsistent and may be influenced by the type of surgery and patient comorbidities. Intravenous dextrose is inexpensive and widely available, but it requires careful monitoring of blood glucose and electrolytes due to the risks of hyperglycemia, osmotic diuresis, and delayed gastric emptying. Future research should focus on optimizing patient selection, the timing and dosing of infusions, and the establishment of standardized protocols. Perioperative intravenous dextrose represents a physiologically sound and cost-effective adjunct for PONV prophylaxis, with potential benefits in select surgical populations when implemented with appropriate monitoring.