Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial

• Published in: PloS one Vol. 10; no. 10; p. e0140294
• Main Authors: van Samkar, Ganapathy, Eshuis, Wietse J, Bennink, Roelof J, van Gulik, Thomas M, Dijkgraaf, Marcel G W, Preckel, Benedikt, de Hert, Stefan, Gouma, Dirk J, Hollmann, Markus W, Busch, Olivier R C
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.10.2015; Public Library of Science (PLoS)
• Subjects: Abdomen; Abdominal surgery; Adult; Aged; Anesthesiology; Clinical trials; Colorectal surgery; Complications; Confidence intervals; Emptying; Female; Fluid restriction; Fluid Therapy; Fluids; Gastric bypass; Gastric emptying; Hospitals; Humans; Isotonic Solutions - administration & dosage; Male; Middle Aged; Mortality; Motivation; Nuclear medicine; Palliative Care; Pancreas; Pancreas - pathology; Pancreas - surgery; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - methods; Participation; Patient outcomes; Patients; Postoperative Complications - pathology; Postoperative Period; Recovery; Researchers; Statistical analysis; Statistical significance; Surgery; Systematic review; Treatment Outcome; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0140294

Perioperative fluid restriction in a variety of operations has shown improvement of: complications, recovery of gastrointestinal function and length of stay (LOS). We investigated effects of crystalloid fluid restriction in pancreatic surgery. Our hypothesis: enhanced recovery of gastrointestinal function. In this double-blinded randomized trial, patients scheduled to undergo pancreatoduodenectomy (PD) were randomized: standard (S:10ml/kg/hr) or restricted (R:5ml/kg/hr) fluid protocols. gastric emptying scintigraphically assessed on postoperative day 7. In 66 randomized patients, complications and 6-year survival were analyzed. 54 patients were analyzed in intention to treat: 24 S-group and 30 R-group. 32 patients actually underwent a PD and 16 patients had a palliative gastrojejunostomy bypass operation in the full protocol analysis. The median gastric emptying time (T½) was 104 minutes (S-group, 95% confidence interval: 74-369) versus 159 minutes (R-group, 95% confidence interval: 61-204) (P = 0.893, NS). Delayed gastric emptying occurred in 10 patients in the S-group and in 13 patients in the R-group (45% and 50%, P = 0.779, NS). The primary outcome parameter, gastric emptying time, did not show a statistically significant difference between groups. A fluid regimen of 10ml/kg/hr or 5ml/kg/hr during pancreatic surgery did not lead to statistically significant differences in gastric emptying. A larger study would be needed to draw definite conclusions about fluid restriction in pancreatic surgery. ISRCTN62621488.