The efficacy of sodium bicarbonated Ringer's solution versus lactated Ringer's solution in elderly patients undergoing gastrointestinal surgery: a prospective randomized controlled trial.

OBJECTIVE

To investigate the effect of sodium bicarbonated Ringer's solution (BRS) on lactate metabolism, acid-base balance, and clinical outcomes in elderly patients undergoing gastrointestinal surgery.

METHODS

A total of 60 elderly patients undergoing gastrointestinal surgery were enrolled in this prospective, randomized controlled study. The participants were randomly assigned to the BRS group (n = 30) or sodium lactated Ringer's solution (LRS) group (n = 30) where they received goal-directed fluid therapy with BRS or LRS, respectively. The primary outcome was the incidence of postoperative hyperlactatemia, whereas the secondary outcomes included pH, bicarbonate, base excess (BE), liver function, and postoperative complications within 30 days. Linear regression was conducted to screen the factors affecting lactate concentration.

RESULTS

After fluid therapy, the probability of hyperlactatemia was lower in the BRS group than in the LRS group (3.3% vs. 40.0%, < 0.001). No significant difference in bicarbonate, pH, and BE was observed between the groups ( > 0.05). Furthermore, the incidence of major complications and the length of hospital stay were not significantly different ( > 0.05). However, the BRS group had a lower risk of minor complications than the LRS group (50.0% vs. 76.7%, = 0.032), particularly in terms of impaired liver function (16.7% vs. 43.3%, = 0.024). Diabetes, hypotension, and volume of LRS infused were highly correlated with lactate concentration.

CONCLUSION

BRS is more beneficial to the reduction of the incidence of postoperative hyperlactatemia and the risk of minor postoperative complications in elderly patients undergoing gastrointestinal surgery. Therefore, BRS may be a better option for perioperative fluid therapy in elderly patients undergoing gastrointestinal surgery.