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A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery
Author(s) -
Lidder P.,
Thomas S.,
Fleming S.,
Hosie K.,
Shaw S.,
Lewis S.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12130
Subject(s) - medicine , placebo , randomized controlled trial , preoperative fasting , surgery , insulin resistance , nutritional supplementation , colorectal surgery , anesthesia , insulin , abdominal surgery , perioperative , alternative medicine , pathology
Aim There is evidence that preoperative carbohydrate drinks and postoperative nutritional supplements improve the outcome of colorectal surgery. There is little information on their individual contribution. Method A prospective four‐arm double‐blind controlled trial was carried out in which patients were randomized to carbohydrate or placebo drinks preoperatively and a polymeric supplement or placebo drink postoperatively. The primary outcome was insulin resistance (using the short insulin tolerance test and HOMA ‐ IR ). Secondary outcomes included handgrip strength, pulmonary function, intestinal permeability and postoperative complications. Results A total of 120 patients were randomized to four demographically well matched groups. Patients who received preoperative and postoperative supplements had better glucose homeostasis ( P = 0.004), peak expiratory flow rate ( P = 0.035), handgrip strength ( P = 0.002) and less insulin resistance ( P = 0.001) compared with those who only received placebo drinks. Conclusion Oral nutritional supplements given preoperatively and postoperatively improve postoperative handgrip strength, pulmonary function and insulin resistance. A weaker effect was seen in patients who received supplements either preoperatively or postoperatively. Oral nutritional supplements should be given both preoperatively and postoperatively.