The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial

Chaudhary, Natasha; Sunuwar, Dev Ram; Sharma, Rachit; Karki, Mandeep; Timilsena, Mukti Nath; Gurung, Anita; Badgami, Sunil; Singh, Devendra Raj; Karki, Pearlbiga; Bhandari, Kailash Kumar; Pradhan, Pranil Man Singh

doi:10.1186/s12891-022-05766-z

Cited by 7 publications

(5 citation statements)

References 61 publications

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“…Eight studies reported postoperative scores of pain scores using a VAS, with data available on 739 participants ( 29 , 35 , 44 , 62 , 67 – 70 ). The results found no statistically significant difference after surgery ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

et al. 2022

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BackgroundPreoperative carbohydrate loading is an important element of the enhanced recovery after surgery (ERAS) paradigm in adult patients undergoing elective surgery. However, preoperative carbohydrate loading remains controversial in terms of improvement in postoperative outcomes and safety. We conducted a Bayesian network meta-analysis to evaluate the effects and safety of different doses of preoperative carbohydrates administrated in adult patients after elective surgery.MethodsMEDLINE (PubMed), Web of Science, EMBASE, EBSCO, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure (CNKI) were searched to identify eligible trials until 16 September 2022. Outcomes included postoperative insulin resistance, residual gastric volume (RGV) during the surgery, insulin sensitivity, fasting plasma glucose (FPG), fasting serum insulin (Fin) level, the serum levels of C-reactive protein (CRP), postoperative scores of pain, patients’ satisfaction, thirst, hunger, anxiety, nausea and vomit, fatigue, and weakness within the first 24 h after surgery and the occurrences of postoperative infection. The effect sizes were estimated using posterior mean difference (continuous variables) or odds ratios (dichotomous variables) and 95 credible intervals (CrIs) with the change from baseline in a Bayesian network meta-analysis with random effect.ResultsFifty-eight articles (N = 4936 patients) fulfilled the eligibility criteria and were included in the meta-analysis. Both preoperative oral low-dose carbohydrate loading (MD: –3.25, 95% CrI: –5.27 to –1.24) and oral high-dose carbohydrate loading (MD: –2.57, 95% CrI: –4.33 to –0.78) were associated with postoperative insulin resistance compared to placebo/water. When trials at high risk of bias were excluded, association with insulin resistance was found for oral low-dose carbohydrate loading compared with placebo/water (MD: –1.29, 95%CrI: –2.26 to –0.27) and overnight fasting (MD: –1.17, 95%CrI: –1.88 to –0.43). So, there was large uncertainty for all estimates vs. control groups. In terms of safety, oral low-dose carbohydrate administration was associated with the occurrences of postoperative infection compared with fasting by 0.42 (95%Crl: 0.20–0.81). In the other outcomes, there was no significant difference between the carbohydrate and control groups.ConclusionAlthough preoperative carbohydrate loading was associated with postoperative insulin resistance and the occurrences of postoperative infection, there is no evidence that preoperative carbohydrate administration alleviates patients’ discomfort.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022312944].

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Section: Resultsmentioning

confidence: 99%

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

et al. 2022

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“…Upon confirmation of a participant's eligibility, the next envelope in the sequence was opened, and the treatment allocation was entered on a randomization list. A similar procedure of randomization technique was used in the previous study [62].…”

Section: Randomizationmentioning

confidence: 99%

“…The VAS consisted of a 10 cm straight line with the endpoints defining the intensity of pain from zero to 10 indicating that zero indicated "no pain at all" and 10 indicated "worst pain". They were asked to express their severity of pain at the time of data collection in a descriptive term as no pain, mild pain, moderate pain, severe pain, or worst pain, and they were ranked to numerical scores for analysis [62]. Another outcome was the plantar fascia thickness which was assessed before intervention (baseline) and after intervention at six months through high-resolution ultrasonography (Ultrasound machine-SONOACE X7) by a trained radiologist.…”

Section: Study Variables Outcome Variablesmentioning

confidence: 99%

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial

Sharma¹,

Chaudhary²,

Karki³

et al. 2023

BMC Musculoskelet Disord

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Background Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF. Methods This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student’s two-sample t-test. P-value < 0.05 was considered statistically significant. Results The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65). Conclusion The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy. Trial registration NCT04985396. First registered on 02 August 2021. (https://clinicaltrials.gov/ct2/show/NCT04985396)

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“…A large number of ERAS protocols along with the European Society for Parental and Enteral Nutrition (ESPEN) guidelines have also recommended the consumption of a carbohydrate-rich drink the night before and 2 hours prior to the surgical procedure to reduce insulin resistance and improve hunger perioperatively in patients undergoing general surgery 66,68 . However, the results of preoperative carbohydrate loading in patients undergoing orthopaedic surgery have been mixed 69,70 . Postoperatively, early resumption of enteral intake is recommended along with the continuation of a protein-rich diet through early rehabilitation.…”

Section: Modifying Nutritionmentioning

confidence: 99%

Nutrition in Surgery: An Orthopaedic Perspective

Zink,

Kent,

Choudhary

et al. 2023

Journal of Bone and Joint Surgery

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➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.

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The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial

Cited by 7 publications

References 61 publications

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial

Nutrition in Surgery: An Orthopaedic Perspective

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