Preoperative fasting abbreviation (Enhanced Recovery After Surgery protocol) and effects on the metabolism of patients undergoing gynecological surgeries under spinal anesthesia: A randomized clinical trial

Marquini, Gisele Vissoci; Pinheiro, Francisco Edes da Silva; Urbano, Alfredo; Pinto, Rogério Melo da Costa; Uyeda, Maria Gabriela Baumgarten Kuster; Girão, Manoel Joâo Batista Castello; Sartori, Marair Grácio Ferreira

doi:10.1016/j.nut.2020.110790

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…12 Various studies and guidelines have clearly recommended preoperative fasting times, 13 14 and preoperative fasting abbreviation protocols such as enhanced recovery after surgery could avoid nausea, vomiting and ileus and accelerate postoperative recovery. [15][16][17][18] As an important part of perioperative nutrition, early feeding after surgery has been shown to accelerate postoperative bowel function recovery. 19 20 Previous studies have supported early intake after gastrointestinal surgery and total laryngectomy, with some guidelines recommending early oral feeding after surgery.…”

Section: Discussionmentioning

confidence: 99%

Current practice of postoperative fasting: results from a multicentre survey in China

et al. 2022

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ObjectiveA gap between clinical practice and evidence is common. The present multicentre study was designed to explore the actual postoperative fasting practice, including the instructed fasting time from the ward staff and the actual postoperative fasting time.DesignMulticentre survey.SettingFour tertiary hospitals in Shenzhen City, China.ParticipantsA total of 988 patients completed a survey on instructed and actual postoperative fasting.OutcomesAll patients received postoperative instructed fasting time from the ward staff. The median instructed fasting time for fluids from ward staff was 6 hours (IQR, 4–6 hours), and the median instructed fasting time for solid food was also 6 hours (IQR 5–6 hours) after surgery. The actual postoperative fasting time, including fluid and solid food intake, was significantly longer than the time recommended by the ward staff (both p<0.001).ResultsThe median time to postoperative first flatus (FFL) was 16.5 hours (IQR 8–25.5 hours), and the median time to postoperative first faeces (FFE) was 41 hours (IQR 25–57 hours). The fasting time was significantly shorter than the time to FFL and the time to FFE, regardless of surgery type or anaesthesia type (all p<0.001). Postoperative nausea and vomiting (PONV) occurred in 23.6% of patients. After surgery, 58.70% of patients reported thirst, and 47.47% reported hunger. No ileus occurred.ConclusionApproximately half of the patients reported thirst and hunger postoperatively. Patients initiated oral intake earlier than the time to FFL or FFE without increasing serious complications. This study may support the rationale for interventions targeting postoperative oral intake time in future studies.

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Section: Discussionmentioning

confidence: 99%

Current practice of postoperative fasting: results from a multicentre survey in China

et al. 2022

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“…Twenty-two studies were included, with data available for 1,379 participants ( 9 , 29 , 30 , 33 , 34 , 36 – 46 , 48 – 50 , 61 , 64 , 65 ). Compared with placebo or water, high-dose carbohydrate loading before surgery was associated with a decrease in Fin level (MD, –5.53 [95%Crl, –10.61 to –0.62]).…”

Section: Resultsmentioning

confidence: 99%

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

et al. 2022

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BackgroundPreoperative carbohydrate loading is an important element of the enhanced recovery after surgery (ERAS) paradigm in adult patients undergoing elective surgery. However, preoperative carbohydrate loading remains controversial in terms of improvement in postoperative outcomes and safety. We conducted a Bayesian network meta-analysis to evaluate the effects and safety of different doses of preoperative carbohydrates administrated in adult patients after elective surgery.MethodsMEDLINE (PubMed), Web of Science, EMBASE, EBSCO, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure (CNKI) were searched to identify eligible trials until 16 September 2022. Outcomes included postoperative insulin resistance, residual gastric volume (RGV) during the surgery, insulin sensitivity, fasting plasma glucose (FPG), fasting serum insulin (Fin) level, the serum levels of C-reactive protein (CRP), postoperative scores of pain, patients’ satisfaction, thirst, hunger, anxiety, nausea and vomit, fatigue, and weakness within the first 24 h after surgery and the occurrences of postoperative infection. The effect sizes were estimated using posterior mean difference (continuous variables) or odds ratios (dichotomous variables) and 95 credible intervals (CrIs) with the change from baseline in a Bayesian network meta-analysis with random effect.ResultsFifty-eight articles (N = 4936 patients) fulfilled the eligibility criteria and were included in the meta-analysis. Both preoperative oral low-dose carbohydrate loading (MD: –3.25, 95% CrI: –5.27 to –1.24) and oral high-dose carbohydrate loading (MD: –2.57, 95% CrI: –4.33 to –0.78) were associated with postoperative insulin resistance compared to placebo/water. When trials at high risk of bias were excluded, association with insulin resistance was found for oral low-dose carbohydrate loading compared with placebo/water (MD: –1.29, 95%CrI: –2.26 to –0.27) and overnight fasting (MD: –1.17, 95%CrI: –1.88 to –0.43). So, there was large uncertainty for all estimates vs. control groups. In terms of safety, oral low-dose carbohydrate administration was associated with the occurrences of postoperative infection compared with fasting by 0.42 (95%Crl: 0.20–0.81). In the other outcomes, there was no significant difference between the carbohydrate and control groups.ConclusionAlthough preoperative carbohydrate loading was associated with postoperative insulin resistance and the occurrences of postoperative infection, there is no evidence that preoperative carbohydrate administration alleviates patients’ discomfort.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022312944].

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“…Recent guidelines of medical societies recommend that the use of preoperative carbohydrate-rich beverages should be encouraged with the purpose to attenuate insulin resistance induced by surgery and starvation after colon, rectal surgical procedures and gynecological surgeries [12,19]. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties [12,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…The authors applied in practice the main recommendations from ERAS protocol (Fig. 1), such as abbreviation for preoperative fasting with 400 ml of clear liquid enriched with carbohydrate and protein 4 hours before urogynecological surgeries (preoperative period), according to previous publications, thromboprophylaxis recommendations in addition to other simple practices such as early oral feeding and pain control to facilitate early ambulation (postoperative period) [11][12][13][14].…”

Section: Participants and Settingsmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) Protocol on Urogynecological Surgeries: 3 years of follow-up after implementation

Marquini¹,

Marra

Samper

et al. 2023

Preprint

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Introduction. The Enhanced Recovery After Surgery (ERAS) protocol for perioperative care recommends positive interventions to accelerate postoperative recovery, such as preoperative fasting abbreviation and prevention of thrombosis. Although applied in other surgical areas, data on its recommendations in urogynecological surgeries are scarce. The aim of this study was to evaluate the plausibility, reproducibility and impact of implementation of the main ERAS recommendations (preoperative fasting abbreviation and prevention of thrombosis) on urogynecological surgeries, in medical practice. Methods. After approval by ethics committee and signature of the free and informed consent form by the patients, a purely observational study was carried out under abbreviation for preoperative fasting with 400 ml of clear liquid enriched with carbohydrate and protein 4 hours and thromboprophylaxis approaches in urogynecological surgeries, from 2015 to 2019 in a medium complexity hospital, with analysis of parameters such as thrombotic events, length of stay and patient satisfaction on recovery after surgery. Results.Of 280 elective surgeries with abbreviation for preoperative fasting, the most frequent urogynecological procedures were: 85 (24.42%) posterior colpoplasties, 67 (19.25%) minor labioplasties and 36 (10.34%) midurethral slings. For venous tromboembolism prophylaxis subcutaneous enoxaparina (0,5mg/Kg) was used in 170 (60.07%) patients at moderate risk for thrombosis and mechanical measures for those at low risk, without thromboembolic complications. Mean hospitalization time was of one day. Conclusions. According to this study, abbreviation of preoperative fasting as described and thromboprophylaxis from ERAS recommendations were plausible, reproducible in medical practice and can be stimulated in urogynecological surgeries to accelerate the postoperative recovery.

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Preoperative fasting abbreviation (Enhanced Recovery After Surgery protocol) and effects on the metabolism of patients undergoing gynecological surgeries under spinal anesthesia: A randomized clinical trial

Cited by 12 publications

References 22 publications

Current practice of postoperative fasting: results from a multicentre survey in China

Current practice of postoperative fasting: results from a multicentre survey in China

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

Enhanced Recovery After Surgery (ERAS) Protocol on Urogynecological Surgeries: 3 years of follow-up after implementation

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