From the Department of Anesthesiology and Pain Medicine (Dr. Seokyung Shin, Dr. Choi, Dr. Kang, and Dr. Kim), the Anesthesia and Pain Research Institute (Dr. Seokyung Shin, Dr. Choi, Dr. Kang, and Dr. Kim), Yonsei University College of Medicine, the Department of Research Affairs (Dr. Hyejung Shin), Biostatistics Collaboration Unit, Yonsei University College of Medicine, and the Department of Orthopedic Surgery (Dr. Yang, Dr. Park, and Dr. Kwon), Yonsei University College of Medicine, Seoul, Korea.
J Am Acad Orthop Surg. 2021 Jan 1;29(1):35-43. doi: 10.5435/JAAOS-D-20-00089.
We evaluated whether preoperative carbohydrate drink would be able to decrease postoperative nausea and vomiting (PONV) and improve the quality of recovery (QoR) in diabetic patients undergoing total knee arthroplasty (TKA).
Eighty-two patients were randomized to either the intravenous (IV) Dextrose group (n = 41) or Oral carbohydrate (CHO) group (n = 41). The IV Dextrose group received dextrose solution mixed with insulin while fasting, and the Oral CHO group received carbohydrate drinks preoperatively. PONV was assessed up to postoperative 36 hours, and QoR was assessed before surgery and on postoperative day (POD) 1. Blood glucose was measured from the morning of surgery until POD 1.
PONV scores were not different between the groups. Postoperative QoR scores were significantly higher in the Oral CHO group (median [interquartile range]; 160 [153 to 167]) than the IV Dextrose group (155 [147 to 159]) (P = 0.009), but the difference did not meet the minimal clinically important difference. Blood glucose was comparable between the groups.
Preoperative CHO drink did not reduce PONV in diabetic patients after total knee arthroplasty. A statistically significant but clinically questionable improvement in the QoR was seen in the Oral CHO group. However, preoperative CHO drink did not increase hyperglycemia, which suggests that it may be a safe component of perioperative care in diabetic patients.
我们评估了术前碳水化合物饮料是否能减少糖尿病患者全膝关节置换术后恶心呕吐（PONV）的发生率，并改善其术后恢复质量（QoR）。
82 名患者被随机分为静脉（IV）葡萄糖组（n = 41）或口服碳水化合物（CHO）组（n = 41）。IV 葡萄糖组在禁食时接受混合胰岛素的葡萄糖溶液，口服 CHO 组在术前接受碳水化合物饮料。PONV 评估至术后 36 小时，QoR 在术前和术后第 1 天（POD1）评估。从手术当天早上到 POD1 测量血糖。
两组的 PONV 评分无差异。术后 QoR 评分在口服 CHO 组（中位数[四分位间距]；160[153 至 167]）显著高于 IV 葡萄糖组（155[147 至 159]）（P = 0.009），但差异未达到最小临床重要差异。两组间血糖无差异。
全膝关节置换术后，术前 CHO 饮料并不能减少糖尿病患者的 PONV。口服 CHO 组的 QoR 有统计学意义但临床意义可疑的改善。然而，术前 CHO 饮料并未导致高血糖，这表明它可能是糖尿病患者围手术期护理的安全组成部分。
