Duration of intravenous fluid replacement after abdominal surgery: a prospective randomised study

Abstract

This prospective randomised study examined the possibility of early resumption of oral hydration and discontinuation of intravenous fluid replacement after emergency or elective abdominal surgery. Following elective cholecystectomy alone or with a choledocholithotomy or an emergency Hartmann's procedure for large bowel obstruction, patients were randomised to early oral hydration (sips of water for 12 h followed by free fluids by mouth for 24 h, when oral intake of food was allowed--intravenous hydration was discontinued 6 h after starting the intake of free fluids orally) or conventional intravenous hydration (intravenous hydration and an oral regimen of water as follows: sips every hour for 12 h, 30 ml every hour for 24 h, 60 ml every hour for 24 h, 90 ml every hour for 24 h, free fluids for 12 h, when food was allowed--intravenous hydration was discontinued 6 h after starting the free fluids). The two regimens were equally effective in maintaining fluid balance and normal plasma and urinary electrolytes without any observed differences in biochemical or metabolic values. Each of free fluids by mouth, discontinuation of intravenous hydration, and consumption of solid food were achieved in the patients on early oral hydration at time periods significantly shorter than those attained with the conventional regimen (P less than 0.001). Similarly, patients on the latter regimen were hospitalised for significantly longer times than those on early oral hydration (P less than 0.001). Early oral hydration after biliary surgery or a Hartmann's procedure effectively maintains fluid balance and has advantages over the conventional intravenous hydration regimen.