Preoperative oral carbohydrate-containing fluid versus plain water in elective cesarean deliveries
OBJECTIVE
Patients posted for elective surgery are allowed to take clear fluids up to 2 hrs before surgery. 
Recent guidelines including Enhanced recovery after surgery (ERAS) guidelines for caesarean section promote oral intake of fluids and carbohydrates in the pre-operative period till 2 hours before surgery as a weak recommendation with low-quality evidence.
With this clinical trial, we wanted to study if the addition of carbohydrates to preoperative oral fluids offers any advantage in terms of preoperative well-being, intraoperative factors and post-operative recovery.DESIGN
Study Design: Randomized, Placebo-Controlled, Single Centre Clinical Trial (CTRI/2021/11/038230)
Duration of Study: One year
Study Population: Parturient women admitted for elective caesarean section under subarachnoid block.
INCLUSION CRITERIA
1)Age 18-45 years
2)Full-term pregnancy (≥37 weeks of gestation)
3)Singleton gestation
4) American Society of Anesthesiology physical class I or II
EXCLUSION CRITERIA:
1) Pre-gestational or gestational diabetes
2) Incomplete gestational diabetes screening
3) History of steroid administration within 7 days prior to planned delivery
4)Current opioid use
METHODS
100 participants were randomized into two groups of 50 participants each using computer generated randomization sequence. Allocation Concealment done using opaque sealed envelopes.
Carbohydrate Group (CHO): Received 400 ml of water mixed with 50 g of glucose orally 2-4 hrs before surgery
Water Group (PW): Received 400 ml of water 2-4 hrs before surgery
OUTCOME MEASURES:
Pre-operative
•Blood Sugar
•VAS score
oThirst
oHunger
oAnxiety
oFatigue
Nausea
Intra-operative
•Hypotension
•Dose of Phenylephrine used (if required)
•Nausea
•Vomiting
•Cord Blood sugar
Post-operative
(Day 1 Post-op)
•Blood Sugar
•QoR-40 (quality of recovery from anesthesia)
RESULTS
Preoperative VAS scores for hunger, thirst, anxiety, nausea and fatigue were similar in both groups.
The occurrence of hypotension(p=0.688) and phenylephrine use (p=0.39) was similar in both groups.
Recovery from anaesthesia, measured by QoR-40 (178.5±2.76 in the CHO group versus 178.52±3.62 in PW group) was comparable in both groups (p=0.92).
Cord blood sugar levels (p=0.24), and preoperative and postoperative blood sugar levels were not significantly different in the groups (p=0.28, p=0.81).
CONCLUSION
This study did not find any significant advantage of adding carbohydrates to oral preoperative fluids in women undergoing elective cesarean delivery under Subarachnoid block.
