[Clinical research on perioperative restrictive fluid therapy combined with preoperative urination training in total...

To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery (ERAS) program for primary total hip arthroplasty (THA).

A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016 (control group) and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017 (trial group). There was no significant difference in gender, age, weight, height, body mass index, primary disease, and complications between 2 groups ( P>0.05). Perioperative related indexes were recorded and compared between 2 groups, including operation time; pre-, intra-, post-operative intravenous fluid volumes, overall intravenous fluid volume on the surgery day; postoperative urine volume per hour after surgery; blood volume; total blood loss during perioperative period; usage rates of diuretics and urine tube; the incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery; postoperative length of stay; and the expressions of inflammatory factors [C reaction protein (CRP), interleukin-6 (IL-6)] before sugery and at 1st and 2nd days after surgery.

The pre-, intra-, post-operative intravenous fluid volumes and the overall intravenous fluid volume on the surgery day in trial group were significantly lower than those in control group ( P<0.05). There was no significant difference in operation time, blood volume, total blood loss during perioperative period, and postoperative urine volume per hour after surgery between 2 groups ( P>0.05). The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group ( P<0.05), while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups were insignificant ( P>0.05). The level of inflammation factors (CRP, IL-6) at 1st and 2nd days was significant lower in trial group than in control group ( P<0.05), with shorter postoperative length of stay ( t=-5.529, P=0.000).

It is safe and effective to adopt restrictive fluid therapy and preoperative urination training during perioperative period (intravenous fluid volume controls in about 1 200 mL on the day of surgery) following ERAS in primary THA. However, prospective studies with large-scale are still in demand for further confirming the conclusion.