Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial
Beibei Wang MD , Dong Han MD , Xinyue Hu MD , Jing Chen MD , Yuwei Liu , Jing Wu MD, PhD
{"title":"Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial","authors":"Beibei Wang MD , Dong Han MD , Xinyue Hu MD , Jing Chen MD , Yuwei Liu , Jing Wu MD, PhD","doi":"10.1016/j.jclinane.2024.111539","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><p>This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization.</p></div><div><h3>Design</h3><p>A prospective randomized controlled trial.</p></div><div><h3>Setting</h3><p>Operating room and gynecological ward in Wuhan Union Hospital.</p></div><div><h3>Patients</h3><p>We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis.</p></div><div><h3>Interventions</h3><p>Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment.</p></div><div><h3>Measurements</h3><p>The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3–4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge.</p></div><div><h3>Main results</h3><p>The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (<em>p</em> < 0.05), with the lower I-FEED score (<em>PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]</em>) and the reduced incidence of I-FEED >2 <em>(PCL:8% vs. PCL-EOF: 2% vs. control:21%).</em> Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 <em>[HR:0.09, 95%CI (0.01–0.72), p</em> <em>=</em> <em>0.023]</em>, and was beneficial in promoting the patient's postoperative first flatus <em>[PCL-EOF: HR:3.33, 95%CI (2.14–5.19),p</em> <em><</em> <em>0.001]</em>, first defecation <em>[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p</em> <em><</em> <em>0.001]</em>, Bristol feces grade 3–4 <em>[PCL-EOF: HR:3.65, 95%CI (2.36–5.63), p</em> <em><</em> <em>0.001]</em>, first fluid diet<em>[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p</em> <em><</em> <em>0.001]</em>, and first normal diet<em>[PCL-EOF: HR:6.63, 95%CI (4.18–10.50), p</em> <em><</em> <em>0.001]</em>. Also, the length of postoperative hospital stay <em>(PCL-EOF: 5d vs. PCL: 6d and control: 6d, p</em> <em><</em> <em>0.001)</em>, the total cost <em>(PCL-EOF: 25052</em> <em>±</em> <em>3650y vs. PCL: 27914</em> <em>±</em> <em>4684y and control: 26799</em> <em>±</em> <em>4775y, p</em> <em>=</em> <em>0.005)</em>, and postoperative VAS pain score values [POD0 <em>(PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p</em> <em><</em> <em>0.001)</em>, POD1 <em>(PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p</em> <em><</em> <em>0.001)</em>, POD2 <em>(PCL-EOF: 1 vs. control:2 vs. PCL: 1, p</em> <em><</em> <em>0.001)</em>, POD3 <em>(PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p</em> <em><</em> <em>0.001)</em>] were significantly reduced in PCL-EOF group.</p></div><div><h3>Conclusions</h3><p>Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery.</p><p><strong>Trial registration</strong>: ChiCTR2300071047(<span>https://www.chictr.org.cn/</span><svg><path></path></svg>).</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0000,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024001685","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study objective
This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization.
Design
A prospective randomized controlled trial.
Setting
Operating room and gynecological ward in Wuhan Union Hospital.
Patients
We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis.
Interventions
Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment.
Measurements
The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3–4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge.
Main results
The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01–0.72), p=0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14–5.19),p<0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p<0.001], Bristol feces grade 3–4 [PCL-EOF: HR:3.65, 95%CI (2.36–5.63), p<0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p<0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18–10.50), p<0.001]. Also, the length of postoperative hospital stay (PCL-EOF: 5d vs. PCL: 6d and control: 6d, p<0.001), the total cost (PCL-EOF: 25052±3650y vs. PCL: 27914±4684y and control: 26799±4775y, p=0.005), and postoperative VAS pain score values [POD0 (PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p<0.001), POD1 (PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p<0.001), POD2 (PCL-EOF: 1 vs. control:2 vs. PCL: 1, p<0.001), POD3 (PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p<0.001)] were significantly reduced in PCL-EOF group.
Conclusions
Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.