Anesthesiology and Resuscitation
doi: 10.25005/2074-0581-2022-24-2-168-175
ENHANCED RECOVERY (FAST-TRACK) PROGRAM IN ELECTIVE ARTHROPLASTY OF WEIGHT-BEARING JOINTS
1Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics, Novosibirsk, Russian Federation
2City Clinical Hospital № 1, Novosibirsk, Russian Federation
Objective: To evaluate the effect of feeding with a whey protein plus carbohydrate drink on metabolic parameters, general state of the patient and recovery time after knee and hip arthroplasty.
Methods: The results of the perioperative period of 60 patients with osteoarthritis (OA) of the hip and knee were evaluated between March and July 2021. All patients underwent hip or knee arthroplasty under spinal anaesthesia. In addition, patients of the study group received the ProvideXtra® Drink 2 hours before surgery. Otherwise, the management of patients in the perioperative period was the standard. Mobilisation and verticalisation of patients were carried out after achieving physical fitness, resolution of the spinal block and haemodynamic stability on the day of surgery or the next day.
Results: In all patients after 4 hours, increased glucose levels were recorded in both groups, statistically significant in the control group – 7.15±0.94 versus 7.88±1.18 mmol/l (p=0.02). The decrease in haemoglobin level had no difference in the study groups and before discharge was 100±16 g/l versus 101±18 g/l (p=0.86). The difference in total protein level before discharge was in favour of the study group, 63.1±6.1 versus 59.2±5.9 g/l (p=0.17). Verticalisation timing in the study group was as follows: 10 patients were verticalised on the day of surgery, and the remaining 20 patients – were on the next day. In the control group – 8 patients were verticalised on the day of surgery and 22 – on the next day. In the control group, 2 cases of postoperative nausea requiring correction were observed.
Conclusion: The modern surgical approaches include the maximal preservation of natural feeding, based on the Enhanced Recovery after Surgery (ERAS®) concept. However, guidelines for choosing a particular diet on the day of surgery remain to be finally established. Using ready-made carbohydrate-protein mixtures is a convenient solution that delivers the required amount of energy and protein. Therefore, the effect of the mixture on protein metabolism in the postoperative period remains to be elucidated through further studies.
Keywords: Accelerated rehabilitation, nutrient mixture, hip arthroplasty, knee arthroplasty.
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Authors' information:
Ageenko Aleksandr Mikhaylovich
Candidate of Medical Sciences, Head of the Department of Anesthesiology and Resuscitation, Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics
Researcher ID: AAP-4020-2020
Scopus ID: 8722380500
ORCID ID: 0000-0001-5033-3012
SPIN: 9888-0447
E-mail: ageenkoam@gmail.com
Nikiforov Dmitriy Sergeevich
Candidate of Medical Sciences, Anesthesiologist- Resuscitator of the Department of Anesthesiology and Resuscitation, Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics
ORCID ID: 0000-0001-5037-4762
SPIN: 7901-2577
E-mail: ndsnsk@yandex.ru
Nikiforova Tatyana Aleksandrovna
Candidate of Medical Sciences, Neurologist, Regional Vascular Center, Resuscitation and Intensive Care Unit № 4 of the City Clinical Hospital No. 1
ORCID ID: 0000-0002-9275-172X
E-mail: tan.post@mail.ru
Lebedeva Maya Nikolaevna
Doctor of Medical Sciences, Head of Research Department of Anesthesiology and Reanimatology, Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics
Researcher ID: R-4135-2019
Scopus ID: 8232968600
ORCID ID: 0000-0002-9911-8919
SPIN: 5169-5532 ID 250952
E-mail: mlebedeva@niito.ru
Information about support in the form of grants, equipment, medications
The authors did not receive financial support from manufacturers of medicines and medical equipment
Conflicts of interest: No conflict
Address for correspondence:
Ageenko Aleksandr Mikhaylovich
Candidate of Medical Sciences, Head of the Department of Anesthesiology and Resuscitation, Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics
630091, Russian Federation, Novosibirsk, Frunze str., 17
Tel.: +7 (913) 9233423
E-mail: ageenkoam@gmail.com