title: Preoperative Nutrition and Postoperative Discomfort in an ERAS Setting: A Randomized Study in Gastric Bypass Surgery.
abstract: BACKGROUND
  Many patients experience postoperative nausea and vomiting (PONV). Preoperative treatment with carbohydrate solutions seems to improve the course after different types of surgery. This study was undertaken to investigate the potential value of different models for preoperative hydration/nutrition, in addition to our ERAS (enhanced recovery after surgery) protocol.
  
  
  METHODS
  Ninety non-diabetic women planned for elective laparoscopic gastric bypass and aged 18-65 years were included. All were on preoperative low-calorie diet (LCD). They were randomized into three arms, either a carbohydrate-rich drink, a protein-enriched drink, or tap water and instructed to drink 800 and 200 mL 16 and 2 h, respectively, prior to operation. Risk factors for PONV were recorded preoperatively. All patients were operated before lunch and received 1500-2000 mL of Ringer-Acetate solution during the 24-30-h postoperative hospital time. Four variables (nausea, pain, tiredness, and headache) were registered on 100-mm visual analog scales six times over 22 h. The need for additional medication was registered.
  
  
  RESULTS
  Out of 90 patients, 73 complete datasets were obtained. Nausea peaked at 7 p.m. but with no statistically significant differences between groups for any of the variables. Pain peaked the first 2 h postoperatively, remained longer, and had not returned to baseline values at 6 a.m. the morning after surgery but with no difference between groups.
  
  
  CONCLUSIONS
  Inside our ERAS protocol, additional preoperative carbohydrate- or protein-enriched fluid treatment did not further reduce immediate patient discomfort in laparoscopic gastric bypass surgery.
authors: Aleris Obesity Academy, Sweden and Norway, St Lars v 45B, SE 222 70, Lund, Sweden.
authors: A
authors: A
authors: Karlsson
authors: Aleris Obesity Academy, Sweden and Norway, St Lars v 45B, SE 222 70, Lund, Sweden.
authors: K
authors: K
authors: Wendel
authors: Aleris Obesity Academy, Sweden and Norway, St Lars v 45B, SE 222 70, Lund, Sweden.
authors: S
authors: S
authors: Polits
authors: Aleris Obesity Academy, Sweden and Norway, St Lars v 45B, SE 222 70, Lund, Sweden.
authors: H
authors: H
authors: Gislason
authors: Aleris Obesity Academy, Sweden and Norway, St Lars v 45B, SE 222 70, Lund, Sweden. Jan.Hedenbro@med.lu.se.|Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden. Jan.Hedenbro@med.lu.se.
authors: J L
authors: JL
authors: Hedenbro
mesh_terms: D000328:Adult; D001628:Beverages; D031204:Caloric Restriction; D002985:Clinical Protocols; D003289:Convalescence; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D060766:Drinking Water; D017558:Elective Surgical Procedures; D005221:Fatigue / Q000628:therapy; D005260:Female; D015390:Gastric Bypass; D006261:Headache / Q000628:therapy; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000178:diet therapy / Q000601:surgery*; D010149:Postoperative Pain / Q000628:therapy; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000178:diet therapy* / Q000188:drug therapy / Q000517:prevention & control*; D011300:Preoperative Care
chemical_list: D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D060766:Drinking Water
keywords: Carbohydrates; Gastric bypass; Nausea; Pain; Preoperative nutrition; Protein