Liberal versus restrictive fluid management in knee arthroplasty: a randomized, double-blind study

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Critical Care Medicine

Background:

• Limited data exists on perioperative fluid volume's impact on organ function.
• Investigating fluid administration strategies is crucial for optimizing patient recovery.

Purpose of the Study:

• To compare the effects of liberal versus restrictive intravascular fluid administration on physiological recovery after knee arthroplasty.
• To evaluate the impact of fluid management on pulmonary function, exercise capacity, coagulation, and patient-reported outcomes.

Main Methods:

• A double-blind study randomized 48 patients undergoing knee arthroplasty to liberal or restrictive fluid groups.
• Standardized perioperative management was applied, with fluid volume as the key variable.
• Outcomes included pulmonary function tests, timed up and go test, thromboelastography, pulse oximetry, and visual analog scales.

Main Results:

• Liberal fluid administration (median 4250 mL) improved pulmonary function at 6 hours postoperatively compared to restrictive (median 1740 mL).
• Significant hypercoagulability was observed 24-48 hours postoperatively in the liberal fluid group.
• A reduced incidence of vomiting was noted with liberal fluid administration, but other recovery variables and hospital stay showed no significant differences.

Conclusions:

• Liberal fluid regimens may enhance early pulmonary function and decrease vomiting after knee arthroplasty.
• However, liberal fluid administration can lead to significant hypercoagulability.
• No significant differences in overall physiological recovery or hospital stay were observed between liberal and restrictive fluid strategies.