Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.

Details

Serval ID
serval:BIB_ECDC7FA1AAA6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.
Journal
Journal of Surgical Research
Author(s)
Hübner M., Schäfer M., Demartines N., Müller S., Maurer K., Baulig W., Clavien P.A., Zalunardo M.P.
Working group(s)
Zurich Fast Track Study Group
Contributor(s)
Müller S., Hübner M., Demartines N., Clavien PA., Zalunardo MP., Maurer K., Werner B., Decurtins M., Eisner L., Castelli I., Keller HP., Langer I., Gelpke H., Grieder F., Carstensen T., Gehrz A., Spahr T., Paganoni R.
ISSN
1095-8673 (Electronic)
ISSN-L
0022-4804
Publication state
Published
Issued date
2012
Volume
173
Number
1
Pages
68-74
Language
english
Notes
Publication types: Journal Article ; Randomized Controlled Trial
Publication Status: ppublish
Abstract
BACKGROUND AND OBJECTIVE: Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction.
METHODS: A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC). Patients with an effective EDA were compared with regard to hemodynamics and renal function.
RESULTS: 61/76 FT patients and 59/75 patients in the SC group had an effective EDA. Both groups were comparable regarding demographics and surgery-related characteristics. FT patients received significantly less i.v. fluids intraoperatively (1900 mL [range 1100-4100] versus 2900 mL [1600-5900], P < 0.0001) and postoperatively (700 mL [400-1500] versus 2300 mL [1800-3800], P < 0.0001). Intraoperatively, 30 FT compared with 19 SC patients needed colloids or vasopressors, but this was statistically not significant (P = 0.066). Postoperative requirements were low in both groups (3 versus 5 patients; P = 0.487). Pre- and postoperative values for creatinine, hematocrit, sodium, and potassium were similar, and no patient developed renal dysfunction in either group. Only one of 82 patients having an EDA without a bladder catheter had urinary retention. Overall, FT patients had fewer postoperative complications (6 versus 20 patients; P = 0.002) and a shorter median hospital stay (5 [2-30] versus 9 d [6-30]; P< 0.0001) compared with the SC group.
CONCLUSIONS: Fluid restriction and EDA in FT programs are not associated with clinically relevant hemodynamic instability or renal dysfunction.
Keywords
Adult, Aged, Aged, 80 and over, Analgesia, Epidural, Anesthetics, Combined, Colectomy, Female, Fluid Therapy/contraindications, Hemodynamics/physiology, Humans, Incidence, Infusions, Intravenous, Kidney/physiology, Length of Stay, Male, Middle Aged, Perioperative Care, Postoperative Complications/epidemiology, Prospective Studies, Water-Electrolyte Balance/physiology
Pubmed
Web of science
Create date
11/09/2011 14:28
Last modification date
20/08/2019 17:14
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