Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Hypocaloric Isonitrogenous Nutrition and Epidural Analgesia: a Novel Strategy to Induce Anabolism After Surgery
Brief Summary: Loss of muscle mass and body protein are the main causes of fatigue after bowel surgery, which may result in a longer hospital stay and a higher rate of complications. This particularly applies to malnourished patients with cancer who undergo surgery with less muscle protein reserves than patients who are well-nourished. Anesthesiologists can favourably influence these undesirable consequences of surgery by choosing the type of pain treatment, i.e. analgesia. Our group recently observed that pain treatment with epidural catheters (these are placed in the so called epidural space, which lies between the spine and the skin of the back), in contrast to the more conventional use of intravenous morphine, can prevent the loss of body protein after surgery.

The goal of the present research program is to study whether this protein sparing effect of epidural analgesia can be further augmented if we feed our patients intravenously with glucose and protein starting the day prior to surgery. We believe that this new concept will not only avoid the increased protein loss after surgery, but will also help patients to build up new protein which is needed to fight the stress caused by the operation.


Options:
A: Arm Label: Fasting; Type: PLACEBO_COMPARATOR; Interventions: Behavioral: Fasting. | Arm Label: Water administration; Type: ACTIVE_COMPARATOR; Interventions: Dietary Supplement: Water administration | Arm Label: carbohydrate drink; Type: ACTIVE_COMPARATOR; Interventions: Dietary Supplement: carbohydrate drink | Intervention Type: DIETARY_SUPPLEMENT; Name: Water administration; Assigned to Arm(s): Water administration | Intervention Type: DIETARY_SUPPLEMENT; Name: carbohydrate drink; Assigned to Arm(s): carbohydrate drink | Intervention Type: BEHAVIORAL; Name: Fasting.; Assigned to Arm(s): Fasting
B: Arm Label: 1; Type: ACTIVE_COMPARATOR; Interventions: Other: Standard ERAS group | Arm Label: 2; Type: EXPERIMENTAL; Interventions: Drug: Post operative laxation (Magnesium Oxide) | Arm Label: 3; Type: EXPERIMENTAL; Interventions: Dietary Supplement: Preoperative metabolic conditioning postoperative nutritional supplementation | Arm Label: 4; Type: EXPERIMENTAL; Interventions: Drug: Post operative laxation (Magnesium Oxide), Dietary Supplement: Preoperative metabolic conditioning postoperative nutritional supplementation | Intervention Type: DRUG; Name: Post operative laxation (Magnesium Oxide); Assigned to Arm(s): 2, 4 | Intervention Type: DIETARY_SUPPLEMENT; Name: Preoperative metabolic conditioning postoperative nutritional supplementation; Assigned to Arm(s): 3, 4 | Intervention Type: OTHER; Name: Standard ERAS group; Assigned to Arm(s): 1
C: Arm Label: A; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Traditional management | Arm Label: B; Type: EXPERIMENTAL; Interventions: Procedure: Fast track patient management | Intervention Type: PROCEDURE; Name: Fast track patient management; Assigned to Arm(s): B | Intervention Type: PROCEDURE; Name: Traditional management; Assigned to Arm(s): A
D: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Other: Intravenous nutrition with glucose and amino acids | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Other: Intravenous nutrition with glucose and amino acids. | Intervention Type: OTHER; Name: Intravenous nutrition with glucose and amino acids; Assigned to Arm(s): 1 | Intervention Type: OTHER; Name: Intravenous nutrition with glucose and amino acids.; Assigned to Arm(s): 2

Answer: D