A Randomized Trial Comparing Two Balanced Crystalloids in Patients Undergoing Emergency Exploratory Laparotomy for Blunt Abdominal Trauma Under General Anesthesia

Intravenous crystalloids are central to perioperative resuscitation of patients with blunt abdominal trauma, in whom haemorrhage and hypoperfusion produce metabolic acidosis and hyperlactatemia. Balanced crystalloids are preferred over 0.9% saline, but it is unclear whether the choice of buffer anion-lactate versus acetate-influences perioperative acid-base and electrolyte status. We compared a lactated balanced crystalloid with an acetated balanced crystalloid in this setting.

In this prospective, randomized, double-blind study conducted at a level-1 trauma centre, sixty adults (18-50 years) undergoing exploratory laparotomy lasting more than one hour for blunt abdominal trauma were allocated to receive a lactated balanced crystalloid (Group R, n = 30) or an acetated balanced crystalloid (Group S, n = 30). Arterial blood gas, base excess, lactate and serum electrolytes were recorded at baseline (preoperative) and after surgery (postoperative). Intergroup and intragroup comparisons were performed using Student's t-test, Mann-Whitney U test, and Chi-square or Fisher's exact test, as appropriate; p < 0.05 was considered significant.

Demographic profiles and duration of surgery were comparable between groups. Group R showed a significant postoperative fall in pH (p = 0.041), whereas pH remained stable in Group S; the postoperative intergroup difference favoured the acetated solution (p = 0.012). Base excess improved significantly within both groups (Group R p = 0.019; Group S p = 0.031), with no significant intergroup difference. Lactate fell significantly in Group S (p = 0.027) but not in Group R, and the postoperative intergroup comparison favoured the acetated solution (p = 0.049). Bicarbonate and all measured electrolytes (Na⁺, K⁺, Cl⁻, Ca²⁺) remained stable, with no significant intra- or intergroup differences.

The acetated solution provided marginally better pH stability and avoided the exogenous lactate load associated with the lactated solution.