Key result
Consuming a carbohydrate drink 2-3 hours before total knee arthroplasty significantly reduced the prevalence of orthostatic hypotension during early mobilization compared to standard fasting (19.4% vs 34.3%, p=0.05).
Why the study?
Preoperative fasting may cause orthostatic hypotension and intolerance that interfere with early mobilization after fast-track total knee arthroplasty, and preoperative carbohydrate loading was hypothesized to reduce this risk.
Does a preoperative carbohydrate drink reduce postoperative orthostatic hypotension in patients undergoing primary total knee arthroplasty?
RCT (n=168)
Open-label
Variable block randomization
No
Does a preoperative carbohydrate drink reduce postoperative orthostatic hypotension in patients undergoing primary total knee arthroplasty?
Consuming a carbohydrate drink prior to total knee arthroplasty significantly reduces the incidence of orthostatic hypotension during early postoperative mobilization.
Preop carbohydrate drink reduces orthostatic hypotension after TKA; supports integration into fast-track protocols and warrants outcome-focused trials.
A key component in fast-track total knee arthroplasty (TKA) is early mobilization. Preoperative fasting might cause orthostatic hypotension and -intolerance which both can interfere with early mobilization. It was hypothesized that consuming a carbohydrate drink 2-3 hours prior to surgery is a viable option to reduce orthostatic hypotension, and as a result, improve rehabilitation. In this randomized controlled trial, all consecutive unilateral primary TKA patients were reviewed for eligibility. Exclusion criteria were American Society of Anesthesiologists (ASA) class above 3, older than 80 years of age, Diabetes Mellitus, and an insufficient comment of Dutch language. Patients were distributed in two groups. The control group was allowed to eat till 6 hours and drink clear fluids till 2 hours before surgery (standard treatment). The intervention group consumed, additionally to the standard treatment, a carbohydrate drink 2-3 hours before surgery. Blood pressure was measured both lying and standing as a measure for orthostatic hypotension during first time postoperative mobilization on day of surgery. A total of 168 patients were included. Prevalence of orthostatic hypotension in the control- and intervention group was 24 patients (34%) and 14 patients (19%) respectively, (p=0.05). Prevalence of orthostatic intolerance was 13 patients (19%) in the control group and 9 patients (13%) in the intervention group (p=0.32). No drink related adverse events occurred. In conclusion, taking a carbohydrate drink 2-3 hours before TKA significantly lowers the number of patients with orthostatic hypotension in early mobilization. However, the clinical relevance of the carbohydrate drink has to be studied further.
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Egmond et al. (2023) conducted an RCT in Primary unilateral total knee arthroplasty (TKA) (n=168). Carbohydrate drink vs. Standard fasting (clear liquids until 2 hours and solid food until 6 hours before surgery) was evaluated on Orthostatic hypotension during first postoperative mobilization on day of surgery (p=0.05). Consuming a carbohydrate drink 2-3 hours before total knee arthroplasty significantly reduced the prevalence of orthostatic hypotension during early mobilization compared to standard fasting (19.4% vs 34.3%, p=0.05).
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