The Effect of Preoperative Oral Carbohydrate or Oral Rehydration Solution on Postoperative Quality of Recovery: A Randomized, Controlled Clinical Trial

Ayako Asakura,Takahiro Mihara,Takahisa Goto,Wan Yee Joseph Lau

doi:10.1371/journal.pone.0133309

Ayako Asakura, Takahiro Mihara + Show 2 more

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https://doi.org/10.1371/journal.pone.0133309

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Abstract

BackgroundNumerous studies have demonstrated the beneficial effects of preoperative administration of oral carbohydrate (CHO) or oral rehydration solution (ORS). However, the effects of preoperative CHO or ORS on postoperative quality of recovery after anesthesia remain unclear. Consequently, the purpose of the current study was to evaluate the effect of preoperative CHO or ORS on patient recovery, using the Quality of Recovery 40 questionnaire (QoR-40).MethodsThis prospective, randomized, controlled clinical trial included American Society of Anesthesiologists (ASA) physical status 1 and 2 adult patients, who were scheduled to undergo a surgical procedure of body surface. Subjects were randomized to one of the three groups: 1) preoperative CHO group, 2) preoperative ORS group, and 3) control group. The primary outcome was the global QoR-40 administered 24 h after surgery. Intraoperative use of vasopressor, intraoperative body temperature changes, and postoperative nausea and vomiting (PONV) were also evaluated.ResultsWe studied 134 subjects. The median [interquartile range (IQR)] global QoR-40 scores 24 h after the surgery were 187 [177–197], 186 [171–200], and 184 [171–198] for the CHO, ORS, and control groups, respectively (p = 0.916). No significant differences existed between the groups regarding intraoperative vasopressor use during the surgery (p = 0.475).ConclusionsResults of the current study indicated that the preoperative administration of either CHO or ORS did not improve the quality of recovery in patients undergoing minimally invasive body surface surgery.Trial Registration www.umin.ac.jp UMIN000009388 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000011029&language=E

Highlights

Enhanced postoperative recovery programs have become widely accepted, and allowing the unrestricted intake of clear liquids until 2 h before anesthesia has been adopted as a standard practice [1].A number of prior studies have examined the effects of preoperative administration of oral carbohydrate (CHO), and have resulted in reports of beneficial effects of CHO on postoperative insulin resistance [2,3], muscle function [4], gut function [5], immunodepression [6], and preoperative discomfort [7]
The purpose of the current study was to evaluate the effect of preoperative CHO or oral rehydration solution (ORS) on patient recovery, using the Quality of Recovery 40 questionnaire (QoR-40)
Results of the current study indicated that the preoperative administration of either CHO or ORS did not improve the quality of recovery in patients undergoing minimally invasive body surface surgery

Summary

Introduction

Enhanced postoperative recovery programs have become widely accepted, and allowing the unrestricted intake of clear liquids until 2 h before anesthesia has been adopted as a standard practice [1].A number of prior studies have examined the effects of preoperative administration of oral carbohydrate (CHO), and have resulted in reports of beneficial effects of CHO on postoperative insulin resistance [2,3], muscle function [4], gut function [5], immunodepression [6], and preoperative discomfort [7]. The effects of CHO or ORS administration on important clinical endpoints such as postoperative quality of recovery (QoR) following anesthesia remain uncertain [9,10]. No prior research has endeavored to compare the effects of preoperative CHO or ORS on postoperative QoR. We considered it important to clarify whether CHO or ORS affected postoperative QoR, which solution was easier to apply in clinical practice, and which would be beneficial for a large number of patients. Numerous studies have demonstrated the beneficial effects of preoperative administration of oral carbohydrate (CHO) or oral rehydration solution (ORS). The effects of preoperative CHO or ORS on postoperative quality of recovery after anesthesia remain unclear. The purpose of the current study was to evaluate the effect of preoperative CHO or ORS on patient recovery, using the Quality of Recovery 40 questionnaire (QoR-40)

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