The Effect Of Reducing Preoperative Fasting Time On Early Postoperative Recovery In Patients Undergoing Total Knee Arthroplasty

Objective:To observe the effect of shortening preoperative fasting and drinking time on the early postoperative recovery of patients undergoing unilateral total knee arthroplasty under total intravenous anesthesia based on the concept of enhance recovery after surgery?ERAS?and multidisciplinary team?MDT?cooperation.Methods:From September 2018 to June 2019,patients who were hospitalized in the Department of orthopaedics of general hospital of Ningxia medical university general hospital were selected to undergo unilateral total knee replacement under total intravenous anesthesia.After MDT discussion before operation,86 patients were randomly divided into the SF group?shortened fasting group,n=43 cases?and the TF group?traditional fasting group,n=43 cases?.In the observation group,6 hours and 2 hours fasting before anesthesia,the total nutrients and clear fluid nutrient solution provided by the nutrition department of general hospital of Ningxia medical university were taken in turn.In the control group,the food and drink were forbidden after 10 o'clock at night on the day before operation.The general data of the patients were recorded.The main observation indexes were the actual fasting and drinking time before operation,the hunger and thirst degree before anesthesia induction,the incidence of reflux aspiration before operation,nausea and vomiting within 24 hours after operation,the changes of blood sugar,mean arterial pressure and heart rate during operation,the first time of getting out of bed after operation,the time of anal exhaust after operation,the pain of vas during the rest period Score.The secondary outcome measures were postoperative sleep quality,hemoglobin,hematocrit and serum albumin changes before and after operation,hospital stay days,total hospital expenses,hospital satisfaction and postoperative complications.Results:1.The age of the two groups?65.74±6.47 vs.65.12±6.35?,the sex between the groups,the male-to-female ratio in the SF group?11 vs.32?,in the TF group?10 vs.33?,and height[?1.61±0.08 vs.1.60±0.07?m],weight[?62.95±10.04 vs.61.86±8.32??],the number of patients with hypertension?18vs.16?,the American Society of Anesthesiologists?ASA?,and other general information was no statistical significance?P>0.05?;2.Compared with the TF group,the SF group had fasting time[?7.64±1.40?h vs.?12.73±2.00?h]and drinking time[?2.64±0.37?h vs.?11.64±2.11?h]before operation,the differences were statistically significant?P<0.05?;the number of patients with moderate and severe hunger before the induction of anesthesia was less in the SF group than in the TF group,and the difference was statistically significant?P<0.05?;Similarly,the number of patients with moderate and severe thirst in the SF group was less than that in the SF group,and the difference was statistically significant?P<0.05?;also there was statistically significant difference in intraoperative fluid replacement between groups?P<0.05?;3.No reflux and aspiration event occurred in the two groups.The number of patients with nausea and vomiting in the observation group within 24 hours after operation was less than that in the control group,the difference between the two groups was statistically significant?P<0.05?.There was no significant difference in the time of first off-bed activity between the two groups?P>0.05?.Compared with the control group,the average anal exhaust time in the SF group was significantly shorter[?8.10±2.43?h vs.?13.90±2.69?h],the difference is statistically significant?P<0.05?;4.Comparison of blood glucose levels between the two groups at the time of the patients before anesthesia induction,out of anesthesia recovery room,and at 1 day after surgery,the differences between the groups were statistically significant?P<0.05?,there was no difference in blood glucose levels at the moment of the start and end surgery?P>0.05?;The difference in blood pressure at operation room?T₀?between the two groups of patients was statistically significant?P<0.05?,and there was no significant difference in blood pressure at other observation time points?P>0.05?;There was no significant difference in heart rate between the two groups of patients at different time points during the operation?P>0.05?;5.Statistical analysis was performed using a generalized estimation equation to analyse pain VAS scores,the results showed that the VAS scores of the SF group were lower than that of the TF group at 12 hours,1 day,2 days,and 3 days after surgery?P<0.05?;there was no significant difference between the two groups with preoperative hemoglobin,hematocrit,and postoperative hemoglobin,hematocrit group?P>0.05?;The albumin in the SF group was higher than that in the TF group[?32.29±3.38 vs.30.98±4.01?g/L],and the difference was statistically significant?P<0.05?;6.The number of postoperative anemia patients in the SF group was less than that in the TF group?3 cases vs.11 cases?,and the difference was statistically significant?P<0.05?.For intramuscular venous thrombosis?4 cases vs.2 cases?,the incidence of there was no significant difference in the two groups?P>0.05?;the average postoperative hospital stay?5 d vs.6 d?and the average total hospital costs in the SF group were less than those in the TF group?42512.66yuan vs.47468.63 yuan?,the difference of two groups was statistically significant?P<0.05?;the hospitalization satisfaction of the SF group was higher than that of the TF group,and the difference was statistically significant?P<0.05?.Conclusion:shorten the time of fasting and water deprivation before surgery can safely and effectively reduce the incidence of hunger,thirst and postoperative nausea and vomiting after surgery,improve the satisfaction of patients during hospitalization,accelerate the early postoperative recovery of patients.