Preoperative carbohydrate loading is strongly recommended by ESPEN as part of the
clinical nutrition in surgery guideline. However, the implementation in clinical setup
halted due to several limitations such as cost consuming, unfamiliar with new protocol
and lack of expertise. Furthermore, there are no studies for preop carbohydrate loading
in AIS as most preop carbohydrate loading is administered as a package for ERAS protocol.
Thus, a strong level of evidence is necessary to propel a change in practice. As such, it
is important to establish the relationship between carbohydrate loading before surgery
and the impact on perioperative outcome.
Understanding the potential benefits of this nutritional intervention in the adolescent
scoliosis population could contribute to the ongoing efforts to optimize surgical care in
these patients. Although preoperative carbohydrates loading has strong recommendation in
spinal fusion ERAS protocol, the level of evident is still scarce, more so in idiopathic
scoliosis. In a systematic review, it has also stated that its limitation as most of the
literature is largely retrospective studies with non-randomised data and cohort studies
lacking formal control groups (Gadiya et al., 2021). Moreover, evidence on other benefits
for carbohydrates loading in scoliosis surgery is still lacking such as its impact on
pain, return of bowel function and post op nausea and vomiting.
This prospective study seeks to fill this knowledge gap by evaluating the influence of
preoperative carbohydrate loading on postoperative outcomes in adolescents undergoing
scoliosis surgery. We hypothesize that preoperative carbohydrate loading will be
associated with an expedited return of bowel function, a reduced incidence of PONV, a
shorter length of hospital stays, improvement in patient general wellbeing and no risk
for aspiration. The objectives of this study are threefold. The primary goal of our study
is to identify whether there is a significant improvement in the return of bowel function
measured by flatus, reducing constipation by days of bowel opening and incidence of
postoperative nausea and vomiting for patients receiving carbohydrate loading in
comparison with patient that do not receive carbohydrate loading. Secondary objective
also include carbohydrate loading and its effect on reducing length of hospital stay
undergoing scoliosis surgery as well as patient overall condition in term of thirst,
hunger and lethargy. The third objective is to measure the residual gastric volume using
ultrasound before induction of anaesthesia.
