The use of a preoperative carbohydrate drink for paediatric spinal fusion patients is not only safe, but significantly improves time to return of bowel function and leads to a positive increase in postoperative comfort levels. This is according to new research which was presented by Jennifer M Bauer (Seattle Children’s Hospital, Seattle, USA) at the Scoliosis Research Society’s (SRS) 57th annual meeting (14–17 September 2022; Stockholm, Sweden), where it won the Louis A. Goldstein Best Clinical Research Poster award.
As rapid discharge protocols for paediatric spine fusion shorten stays, gastrointestinal (GI) limitations including constipation, emesis, and paralytic ileus are uncovered and cause delays in discharge or readmission, note the study authors. A preoperative carbohydrate drink has been shown to improve perioperative GI symptoms and function return in some patients, but has not been examined in paediatric nor spine patients, they add.
Bauer et al prospectively randomised American Society of Anaesthesiologists (ASA) 1+2 classification paediatric spine fusion patients who were above seven years of age to either pre-anaesthesia carbohydrate drink which was consumed two hours prior to surgery, or to a control group of standard eight hour nothing by mouth (nil per os [NPO]).
Time to return of flatus and first bowel movement, as well as GI symptoms such as emesis events or extra GI treatment such as suppository, were documented. Comfort scores were also collected preoperatively and twice daily for 72 hours postop or until discharge, as well as standard spine surgery related variables, morphine equivalents, and patient reported outcomes.
The study included 14 patients who were randomised to the control group and 20 to the carbohydrate drink group. The findings showed that there was no significant difference between the groups in total anaesthesia duration, with the carbohydrate drink group averaging 1.9 fewer levels fused (p=0.38) and 72cc less EVL (p=0.13).
There were no perioperative aspiration or other anaesthetic complications related to ingestion of the preoperative drink. The group that received the drink also had earlier return of flatus, with 69% vs. 33% return at 24 hours (p=0.04), and 100% by 48 hours vs. 100% by 72 hours.
In addition, there was no difference in return of bowel movement prior to discharge (15% drink vs. 14% control, p=0.9). Preoperative and 12-hour postoperative comfort scores were no different, but the drink group reported less nausea on a 0–100 scale at 24 hours (p=0.03), and less anxiety at both 24 hours (p=0.001) and 36 hours (p=0.017).
Speaking to Spinal News International, Bauer said: “Looking at ways to optimise our patients’ perioperative course is important. As in this case, we may be able to learn from other specialties’ strategies with our anaesthesia teams and adapt them to our patients.
“This was only a small pilot study, and thus more research should be done, but a pre-op carbohydrate drink for our patients was safe, and may help their recovery.”
