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Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial
Södertalje Hospital, Sweden Karolinska Institute, Sweden.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
2012 (English)In: Trials, ISSN 1745-6215, Vol. 13, no 97Article in journal (Refereed) Published
Abstract [en]


Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L) rather than to the nutrients.


Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine), muscle catabolism (urinary 3-methylhistidine), and wellbeing.


Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (−48%) and was due to an increased insulin response (+51%). Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups.


Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery.

Place, publisher, year, edition, pages
BioMed Central , 2012. Vol. 13, no 97
Keyword [en]
Glucose tolerance test, Glucose clearance, Insulin resistance, Cortisol, complications, W-BQ12, Health index
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-84540DOI: 10.1186/1745-6215-13-97ISI: 000308892100001OAI: diva2:560161

Funding Agencies|Olle Engkvist Byggmastare Foundation||Stockholm County Council|2009-0433|

Available from: 2012-10-12 Created: 2012-10-12 Last updated: 2013-06-14

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Hahn, Robert G
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AnesthesiologyFaculty of Health SciencesDepartment of Anaesthesiology and Surgery UHL
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