Acta Orthop Belg. 2023 Sep;89(3):485-490. doi: 10.52628/89.3.11930.
A key component in fast-track total knee arthroplasty (TKA) is early mobilization. Preoperative fasting might cause orthostatic hypotension and -intolerance which both can interfere with early mobilization. It was hypothesized that consuming a carbohydrate drink 2-3 hours prior to surgery is a viable option to reduce orthostatic hypotension, and as a result, improve rehabilitation. In this randomized controlled trial, all consecutive unilateral primary TKA patients were reviewed for eligibility. Exclusion criteria were American Society of Anesthesiologists (ASA) class above 3, older than 80 years of age, Diabetes Mellitus, and an insufficient comment of Dutch language. Patients were distributed in two groups. The control group was allowed to eat till 6 hours and drink clear fluids till 2 hours before surgery (standard treatment). The intervention group consumed, additionally to the standard treatment, a carbohydrate drink 2-3 hours before surgery. Blood pressure was measured both lying and standing as a measure for orthostatic hypotension during first time postoperative mobilization on day of surgery. A total of 168 patients were included. Prevalence of orthostatic hypotension in the control- and intervention group was 24 patients (34%) and 14 patients (19%) respectively, (p=0.05). Prevalence of orthostatic intolerance was 13 patients (19%) in the control group and 9 patients (13%) in the intervention group (p=0.32). No drink related adverse events occurred. In conclusion, taking a carbohydrate drink 2-3 hours before TKA significantly lowers the number of patients with orthostatic hypotension in early mobilization. However, the clinical relevance of the carbohydrate drink has to be studied further.
快速通道全膝关节置换术（TKA）的一个关键组成部分是早期活动。术前禁食可能导致直立性低血压和不耐受，这两者都会干扰早期活动。据推测，在手术前 2-3 小时摄入碳水化合物饮料是减少直立性低血压的可行选择，从而改善康复。在这项随机对照试验中，所有连续的单侧初次 TKA 患者都进行了资格审查。排除标准为美国麻醉医师协会（ASA）分级超过 3 级、年龄大于 80 岁、糖尿病和荷兰语表达不充分。患者分为两组。对照组允许在术前 6 小时内进食，2 小时内饮用清亮液体（标准治疗）。干预组除了接受标准治疗外，还在术前 2-3 小时内饮用碳水化合物饮料。在手术当天首次术后活动时，测量卧位和立位血压，以评估直立性低血压。共有 168 名患者入组。对照组和干预组直立性低血压的发生率分别为 24 例（34%）和 14 例（19%）（p=0.05）。对照组直立不耐受的发生率为 13 例（19%），干预组为 9 例（13%）（p=0.32）。没有与饮料相关的不良事件发生。结论：在 TKA 前 2-3 小时摄入碳水化合物饮料可显著降低早期活动中直立性低血压患者的数量。然而，碳水化合物饮料的临床相关性还需要进一步研究。
