Journal of Clinical Medicine (Jul 2023)

Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia—A Randomized Controlled Trial

  • Katarzyna Kotfis,
  • Arleta Wojciechowska,
  • Małgorzata Zimny,
  • Dominika Jamioł-Milc,
  • Aleksandra Szylińska,
  • Sebastian Kwiatkowski,
  • Karolina Kaim,
  • Barbara Dołęgowska,
  • Ewa Stachowska,
  • Maciej Zukowski,
  • Maria Pankowiak,
  • Andrzej Torbé,
  • Paul Wischmeyer

DOI
https://doi.org/10.3390/jcm12154978
Journal volume & issue
Vol. 12, no. 15
p. 4978

Abstract

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Background: Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. Methods: A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control—standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. Results: A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p p p = 0.001) and glucose (p p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p p < 0.001) were higher in the CHO group than in the control group. Conclusions: There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. Trial registration: ClinicalTrials.gov identifier: NCT04069806.

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