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:10.3390/jcm12154978

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

J Clin Med. 2023 Jul 28;12(15):4978. doi: 10.3390/jcm12154978.

Affiliations

¹ Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
² Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
³ Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland.
⁴ Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland.
⁵ Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
⁶ Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA.

Abstract

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 < 0.001) and thirst (p < 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p < 0.001), lower F2-isoprostane in plasma (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 < 0.001) and lactate (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.

Keywords: ERAS; F2-isoprostane; OCH; PONV; cesarean section; fasting; nausea; obstetrics; oral carbohydrate; outcomes; vomiting.

Associated data

ClinicalTrials.gov/NCT04069806

Grants and funding

This research received no external funding. The primary investigator (K.K.) of the POC-NaVoP study received financial support from Nutricia Polska Sp. z o.o. to perform biochemical analyses (CRU/1605/2019/Kw). The financial contributor had no role in the study design, data collection, analysis, and interpretation of data, writing the report, and the decision to submit the report for publication.