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Saline versus Lactated Ringer's Solution: The Saline or Lactated Ringer's (SOLAR) Trial
Kamal Maheshwari1, Alparslan Turan, Natalya Makarova
1From the Department of General Anesthesiology (K.M., A.T., W.A.S.E., K.R., S.B., A.G.K., M.R.R., T.K., G.R.B., A.K.) Department of Outcomes Research (K.M., A.T., N.M., C.M., K.R., H.E., B.C., I.S., G.R.B., D.C., E.J.M., A.K., D.I.S.) Department of Quantitative Health Sciences (N.M., C.M., E.J.M.) Department of Orthopedic Surgery (C.H.-R.), Cleveland Clinic, Cleveland, Ohio the Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida (L.S.) the Division of Anesthesia, Critical Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (B.C.) the Department of Anesthesia, St. Elizabeth's Medical Center, Boston, Massachusetts (I.S.).
For surgical patients, lactated Ringer's solution and normal saline showed no significant difference in major postoperative complications or mortality. Clinicians can use either fluid for intraoperative volume replacement in orthopedic and colorectal surgery.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Surgical Critical Care
- Fluid and Electrolyte Management
Background:
- Saline administration in surgery can lead to hyperchloremic acidosis and potential complications.
- The study addresses the clinical question of whether lactated Ringer's solution offers an advantage over normal saline in surgical patients.
Purpose of the Study:
- To test the hypothesis that lactated Ringer's solution reduces the composite of in-hospital mortality and major postoperative complications compared to normal saline.
- To evaluate the impact of fluid choice on postoperative acute kidney injury.
Main Methods:
- An alternating cohort controlled trial involving adult patients undergoing colorectal and orthopedic surgery.
- Patients received either lactated Ringer's solution or normal saline in alternating 2-week blocks.
- Primary outcome: composite of in-hospital mortality and major postoperative complications; Secondary outcome: postoperative acute kidney injury.
Main Results:
- No clinically meaningful difference in the primary composite outcome between lactated Ringer's (5.8%) and normal saline (6.1%) groups.
- No significant difference in postoperative acute kidney injury rates (6.6% vs 6.2%).
- Absolute differences in outcomes were less than 0.5%, considered clinically insignificant.
Conclusions:
- Elective orthopedic and colorectal surgery patients showed no meaningful difference in postoperative complications with either lactated Ringer's or normal saline.
- Either fluid solution can be reasonably used for intraoperative volume replacement.
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