Preoperative free access to water compared to fasting for planned cesarean under spinal anesthesia: a randomized controlled trial - 20/11/24
Abstract |
Background |
Contemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women.
Objective |
This study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction.
Study Design |
A randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized: 252 undergoing preoperative free access to water up to the call to dispatch to the operating theater (intervention group) and 252 undergoing fasting from midnight (fasting arm). The primary outcomes were perioperative vomiting and maternal satisfaction. Analyses were performed using t test, Mann-Whitney U test, and chi-square test, as appropriate.
Results |
Of note, 9 of 252 patients (3.6%) in the intervention group and 24 of 252 patients (9.5%) in the control group had vomiting at up to 6 hours after completion of cesarean delivery (relative risk, 0.38; 95% confidence interval, 0.18–0.79; P=.007), and the maternal satisfaction scores (0–10 visual numerical rating scale) were 9 (interquartile range, 8–10) in the intervention group and 5 (interquartile range, 3–7) in the control group (P<.001). Assessed before dispatch to the operating theater, feeling of thirst was reported by 69 of 252 patients (27.4%) in the intervention group and 134 of 252 patients (53.2%) in the control group (relative risk, 0.52; 95% confidence interval, 0.41–0.65; P<.001), capillary glucose levels were 4.8±0.7 mmol/L in the intervention group and 4.9±0.8 mmol/L in the control group (P=.048), and preoperative intravenous fluid hydration was commenced in 49 of 252 patients (19.4%) in the intervention group and 76 of 252 patients (30.2%) in the control group (relative risk, 0.65; 95% confidence interval, 0.47–0.88; P=.005). In the operating theater, ketone was detected in the catheterized urine in 38 of 252 patients (15.1%) in the intervention group and 78 of 252 patients (31.0%) in the control group (relative risk, 0.49; 95% confidence interval, 0.25–0.59; P<.001), and the numbers of doses of vasopressors needed to correct hypotension were 2.3±1.7 in the intervention group and 2.7±2.2 in the control (P=.009). The recommendation rates for preoperative oral intake regimen to a friend were 95.2% (240/252) in the intervention group and 39.7% (100/252) in the control group (relative risk, 2.40; 95% confidence interval, 2.06–2.80; P<.001), in favor of free access to water. Other assessed maternal and neonatal outcomes were not different.
Conclusion |
Compared with fasting, free access to water in planned cesarean delivery reduced perioperative vomiting and was strongly favored by women. In addition, several pre- and intraoperative secondary outcomes were improved. However, postcesarean delivery recovery and neonatal outcomes were not different.
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Key words : cesarean, oral intake, preoperative, satisfaction, spinal anesthesia, vomiting
Plan
| This study was conducted at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. |
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| The authors report no conflict of interest. |
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| This research was internally funded by the Department of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia. |
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| This trial was approved by the University of Malaya Medical Centre Medical Research Ethics Committee on September 28, 2020 (reference number: 2020623-8813). |
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| This study is registered in the International Standard Randomised Controlled Trial Number (ISRCTN) registry on October 1, 2020 (registration number: ISRCTN63282932; ISRCTN63282932). The first participant was recruited on October 2, 2020. |
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| Individual participant data will be available, particularly individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices). Another document that will be available is the trial protocol. Data will be available beginning 3 months and ending 5 years after article publication to investigators whose proposed use of the data has been approved by an independent review committee identified for the purpose of individual participant data meta-analysis only. Proposals should be directed to P.C.T. (pctan@um.edu.my). |
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| Cite this article as: Ng YL, Segaran S, Yim CCW, et al. Preoperative free access to water compared to fasting for planned cesarean under spinal anesthesia: a randomized controlled trial. Am J Obstet Gynecol 2024;231:651.e1-11. |
Vol 231 - N° 6
P. 651.e1-651.e11 - décembre 2024 Retour au numéro
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