The Effect of Oral Carbohydrate Solution on Anxiety and Comfort in Patients Undergoing Hip Arthroplasty
Condition: Hip Arthropathy; Fasting; Patient Comfort
MeSH terms: Joint Diseases
Study type: Interventional

Summary: 
      Surgical interventions are not only a physiological trauma, but also a psychological and
      social trauma because they cause deterioration of the individual's comfort. Comfort is among
      the most basic human needs and provides a better care output. One of the conditions that
      cause deterioration of comfort and anxiety in patients is hunger and thirst before surgery.
      Since 1994, several guides published by professional groups in many countries on
      pre-operative fasting periods have published that clear liquids can be taken up to 2 hours
      before the surgery in elective surgeries, and solid foods can be taken up to 6 hours before
      the surgery. One of the basic principles of ERAS protocols, which include evidence-based care
      interventions applied at all stages of the surgical process, for the preoperative period is
      to ensure that the patient takes a carbohydrate drink up to two hours before anesthesia and
      to shorten the long fasting period. In many countries, the problems experienced by patients
      as a result of long-term hunger have been identified. When the comfort status of the patients
      who were given carbohydrate-rich drinks before the surgery was examined, it was observed that
      the symptoms such as thirst, hunger, insufficiency, fatigue, nausea, pain, anxiety and
      depression were reduced and oral carbohydrate solutions were recommended. In the literature,
      it is stated that the prolongation of the fasting period causes an increase in the anxiety of
      the person and negatively affects his comfort, and it is recommended to drink 800 ml of
      carbohydrate liquid food until midnight the day before the surgery and 400 ml of liquid
      carbohydrate food 2-3 hours before the surgery in order to provide metabolic satiety. The
      nurse, who is one of the health workers responsible for the care of the patient, has to
      manage the restriction of oral food and liquid intake and the comfort of the patient in the
      best way before the operation. Accordingly, in our study, the answers were sought whether the
      oral carbohydrate solution given before hip arthroplasty had an effect on anxiety and patient
      comfort.
    

Detailed description: 
      Hip arthroplasty (HA) is a very common treatment method in orthopedic surgery worldwide. HA
      is considered a successful, safe and cost-effective medical intervention to regain pain-free
      mobility and functionality of the hip joint in patients with severe joint disease or trauma.

      It is stated that the annual number of patients undergoing HA in the United States is
      193,000, and this number is approximately one million worldwide. In the next 15 years, it is
      estimated that the number of patients undergoing HA will continue to increase in the world
      and in Turkey.

      It is stated that health care services should start in the preoperative period and continue
      in the postoperative period, especially in HA surgeries performed due to limitation of
      mobility. Because HA application is seen as a major surgical intervention and as with many
      surgical interventions, it can affect the individual as a whole.

      Surgical intervention is a combination of anesthesia, drug therapy, tissue trauma, blood loss
      and body temperature changes. These developing events stimulate metabolic changes and cause
      postoperative anxiety and stress response at the same time. Exposure of the human body to
      surgery or other trauma elicits a neurohumoral response and activates a catabolic process.
      Surgical stress causes an increase in the release of regulatory hormones such as
      catecholamine, glucagon and cortisol in the body and a decrease in insulin sensitivity. The
      increase in cortisol level leads to the development of insulin resistance and hyperglycemia,
      which have an important effect on the healing process. Changes in this process increase the
      risk of postoperative complications and mortality.

      On the other hand, fasting the patient overnight as a standard practice in the preoperative
      period in order to reduce the risk of lung aspiration in elective surgery patients may cause
      a change in the insulin glucagon ratio. This increases the stress response to surgical trauma
      and may have a major impact on glycemic control and insulin resistance. Prolongation of the
      preoperative fasting period may cause negative effects such as feeling of hunger, anxiety,
      restlessness, headache, dehydration, hypovolemia and hypoglycemia. However, the increase in
      the preoperative fasting period causes a decrease in patient satisfaction, and causes
      undesirable conditions such as nausea and vomiting in the postoperative period, delaying the
      healing process and prolonging the hospital stay of the patients.

      In the guidelines published in countries such as America, Canada and Europe, it is reported
      that the longer the fasting period, the negative effects on patient safety and comfort. In
      elective surgeries, it is recommended that clear liquids can be consumed up to the last two
      hours and solid foods up to six hours before the surgical procedure in order to reduce
      anxiety, reduce the negative effects of the stress response on the patient, and ensure
      patient comfort. In the guideline published by the Turkish Society of Anesthesiology and
      Reanimation (TARD) in 2005, it is recommended to comply with these criteria in patients who
      will undergo elective surgery. Therefore, modern perioperative care aims at maximizing the
      shortening of the fasting period before an elective surgery.

      According to Enhanced Recovery After Surgery (ERAS) protocols, one of the elements of modern
      perioperative care is the administration of preoperative oral carbohydrate loading (OCS). In
      the literature; oral carbohydrate solution administration before elective surgery; It is
      stated that it is absorbed from the stomach of the patient in an average of 90 minutes,
      reduces protein catabolism in the muscles, increases glycogen storage in the liver and
      reduces insulin resistance. In addition, in other studies conducted in abdominal, orthopedic
      and cardiac surgery; It has been determined that OCS reduces postoperative metabolic stress,
      preserves lean body mass and muscle strength, and increases patient comfort by reducing the
      length of hospital stay.

      The concept of patient comfort is defined as the comfort that facilitates daily life. In
      providing the health care needs, which are extremely stressful for the patient, nurses apply
      nursing interventions for comfort, which is a concept unique to the individual, allowing the
      patient to experience less anxiety, be more peaceful and overcome their problems.

      Discomforts experienced by the patient during the operation or procedures (pain, nausea,
      vomiting, hypothermia, anxiety, etc.) may increase the patient's anxiety and may be the main
      reason for the decrease in comfort. The nurse should provide all necessary nursing
      interventions to reduce or eliminate the situations that will cause anxiety in the patient
      before and after each procedure to be applied to the patient. With all these practices,
      patients can receive a quality nursing care, contribute to their faster recovery and increase
      their quality of life.

      Quality patient care in surgical nursing; should be shaped within the framework of ethical
      principles such as not harming and providing benefit. In the literature; Evidence for the
      duration of fasting in the preoperative period is reflected in clinical practice, emphasizing
      the need to prevent patients from being harmed without putting them at risk. Thus, by
      managing the hunger period within the scope of evidence-based practices; It is stated that
      many therapeutic benefits can be obtained, such as reducing anxiety, discomfort, headache,
      thirst and hunger in the preoperative period, and providing patient comfort by reducing
      nausea, vomiting and dehydration in the postoperative period.

      Managing food and fluid restriction in line with the guidelines in the preoperative period is
      one of the important responsibilities of the surgical nurse. Thus, the comfort of the
      patients will be increased, their anxiety will be reduced, and they will be able to return to
      their normal lives as soon as possible. Working from here; It was aimed to determine the
      effect of preoperative OCS on anxiety and patient comfort in patients undergoing HA.
    

Intervention name(s): oral carbohydrate solution
Intervention type(s): Dietary Supplement
Intervention description(s): Patients in the intervention group; Preop oral carbohydrate solution was ingested orally twice within 10 minutes, as 800 ml at 24:00 the night before the surgery and 400 ml at 06:00 2 hours before the surgery.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled clinical trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: oral carbohydrate solution; anxiety; comfort