Jelly snakes to reduce early postoperative vomiting in children after adenotonsillectomy: The randomized controlled snakes trial

Background: Despite the use of dual antiemetic agents, postoperative nausea and
vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects
postoperatively in young children.
Methods: Prospective, open-label randomised controlled trial of 240 patients,
2–16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was
the number of episodes of vomiting within 6 h of the operation on an
intention-to-treat basis. Secondary outcomes: incidence of nausea, vomiting
at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge.
Results: 233 patients were randomised to receive the confectionary snake
(snake group, 118) or standard care (control group, 115). The number of
vomiting episodes in 6 h was similar between groups on an intention-to-treat
basis, with 39 episodes across 22 (19%) patients in the control group and 31
across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic
care unit until 24 h there was no difference in doses of antiemetics or delayed
discharge due to PONV. A secondary as per protocol analysis did not change
this result.
Conclusions: Chewing of confectionery jelly snakes within one hour of waking
following adenotonsillectomy with vapour-maintained anaesthesia and two
prophylactic antiemetics did not further reduce the incidence of early
vomiting.