A restrictive dose of crystalloids in patients during laparoscopic cholecystectomy is safe and cost-effective: prospective, two-arm parallel, randomized controlled trial

Abstract

PurposeThere are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate.Patients and methodsIn this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer’s solution intraoperatively. There were 40 patients in each group. Each patient’s hemodynamic parameters and laboratory values (arterial blood gas and lactate levels) were measured together with their consumption of crystalloids, volatile anesthetics, and analgesics.ResultsAnalysis of the hemodynamic and laboratory parameters revealed no signs of global hypoperfusion in any of the groups analyzed. There was no significant difference in the duration of surgery and anesthesia, but the consumption of crystalloids, volatile anesthetics, and opioids was significantly lower in the restrictive group, compared with the low and high liberal groups. Although there was no significant difference in the 1-year morbidity among the groups, heart failure was observed in one patient in the high liberal group in the early postoperative period.ConclusionRestrictive fluid therapy during laparoscopic cholecystectomy is justified, safe, and more cost-effective than other options.

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

“…Perioperative fluid management One RCT 113 found a significant improvement in day case rate in patients who received a liberal intraoperative intravenous fluid regimen, however, a further four RCTs [114][115][116][117] found no significant difference in mean LOS. None of these studies were amenable to meta-analysis due to heterogenous reporting of LOS outcomes.…”

Restricted Versus Liberal Versus Goal-Directed Fluid Therapy for Non-vascular Abdominal Surgery: A Network Meta-Analysis and Systematic Review

“…Perioperative fluid management is an important factor in perioperative care that contributes to long-term mortality and morbidity [1] and is frequently debated amongst perioperative physicians [2][3][4][5][6]. The three current options are restrictive fluid therapy (RFT), goal-directed fluid therapy (GDT) and liberal fluid hand-searched to avoid missing relevant studies.…”