Preoperative carbohydrate load and the level of postoperative pain, anxiety and nausea in patients undergoing breast surgery

Abstract

Background: Preoperative caloric load, 3 hours before the surgery has been de- bated in relation to major surgeries and as a part of the Enhanced Recovery After Sur- gery Protocols (ERAS) during the last decades1. Its influence on the postoperative com- plications and unwanted events has been elaborated and proved in several studies1,2. However, its influence in nondiabetic patients and its correlation to postoperative pain and anxiety in breast surgery has still not become a part of the protocols. The aim of our study was to analyze the occurrence of postoperative pain, anxiety, nausea and glycemia in patients undergoing breast surgery. Method and material: In a prospective study 40 female patients, aged 40-60, non-diabetic (preoperative Hb A1c<5.7mmol/l), ASA I, II, scheduled for radical mas- tectomy at the University Clinic for thoracic surgery, Skopje from January 2022 to April 2022 were included in the study. In the study patient with diabetes melitus, EF<50%, after hemotherapy, with renal or endocrine diseases were not included in the study. Patients, with computer-based randomization were divided into two groups. Patients in Group A received 3 hours preoperatively carbohydrate drink* of 200 ml, whereas pa- tients in group B received an equal amount of tap water. All patients underwent stand- ardized anesthesia and post-operative analgesia protocol. In all patients we analyzed the demographic data, the level of glycemia, and according to the Visual Analog Scale (VAS in mm) the level of pain, anxiety, and nausea 12 and 24 h postoperatively. Furthermore, we analyzed the level of additional analgesia needed postoperatively with tramadol. Results: Preoperative demographic characteristic in the groups were homoge- nic. Mean age in group A was 56.3 years + 4.7 SD, while in group B was 56.7 years + 2.9 SD. Level of anxiety was moderate in both groups preoperatively (after the drink), but not significantly lower in the patients in the first group (6.3 vs 7.7) while pain and nausea were low for that time measurements for both groups. On the other hand, 12h 318 PROCEEDINGS postoperatively pain was on average 2.3 vs 4.5; anxiety was 5.3 vs 5.7 and nausea oc- curred with average score of 5.2 and 2.7 and glycemia was significantly higher in the group B in respect to the groups. 24 h after the operation was no significant difference in the VAS score for all three parameters between the groups. In the group B 50% of the patients needed additional analgesia during the first 12 h. Conclusion: Carbohydrate loading with 200ml of solution 3h preoperatively low- ers the pain and the need for additional analgesia during the first 12 h postoperatively. Furthermore, it influences on lowering the postoperative glycemia, nausea and anxiety in female patients undergoing breast surgery. However, more randomized studies are needed. *the content of the solution was: water, maltodextrin, fructose, sodium citrate, aroma with osmolarity of 240mOsmol/L.