Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial.

CONTEXT: Perioperative oral carbohydrate intake is beneficial to general surgery patients. Total hip arthroplasty is a common surgical procedure, and even a moderate improvement in patient outcome could have a significant effect on the resources needed for these patients. However, few studies have focused on the effects of carbohydrate intake on orthopaedic patients. OBJECTIVE: The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty. The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate. DESIGN: A randomised, double-blind, controlled trial. SETTING: This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery. PATIENTS: Sixty ASA physical status I-III patients scheduled for elective total hip arthroplasty were included. Exclusion criteria were obesity, diabetes, prior hip surgery to the same hip, ongoing infection, immunological deficiency or age less than 50 or more than 80 years. INTERVENTIONS: Patients were given 400 ml of either an oral 12.5% carbohydrate solution or a placebo beverage (flavoured water) 1.5 h before and 2 h after surgery. MAIN OUTCOME MEASURES: Visual analogue scales were used to score six discomfort parameters. RESULTS: Immediately prior to surgery, the carbohydrate-treated patients were less hungry (median score 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (P < 0.05). Postoperatively, patients in the carbohydrate group experienced less pain at 12, 16 and 20 h (median scores 20, 30 and 34 vs. 7, 5 and 0 mm; P < 0.05). CONCLUSION: This study shows that there is limited benefit from administering oral carbohydatre prior to total hip arthroplasty