A randomized controlled trial of the impact of perioperative supplementation with immunonutrition on surgical outcome and pain in oral cavity or mandibular tumor resection

Abstract

Objectives: The current research investigated the impact of adding immunonutrition mixture before surgery to the standard feeding regimen for patients undergoing oral cavity or mandibular tumor resections.

Methodology: This randomized double-blind controlled trial comprised 176 cancer patients undergoing resection of oral cavity or mandibular tumors. Participants were evenly divided into two groups: Group I (Immunonutrition group) got perioperative supplementation with omega-3 taken orally and L-Alanyl-L-Glutamine (Dipeptiven) administered via intravenous infusion, in addition to the standard feeding. Group C (Control group) received only standard feeding, which included a caloric distribution of protein 10-35%, fats 20-35%, and carbohydrates 45-65%. Both groups were followed for the primary outcome, set as wound infection and duration of hospital stays. The secondary outcome, included total dose of intraoperative opioids, postoperative VAS at 0 h ,4 h, 8 h and 12 h, intraoperative hemodynamics and any postoperative complications e.g., fever, neutropenia and pneumonia.

Results: A significant difference in postoperative complications in both groups was observed; wound infection was (1.14% vs. 7.95%) for Groups I and C respectively (P = 0.03). Group I was significantly lower in fever and neutropenia vs Group C (P < 0.01). No significant difference in hospital stay was noted in both groups. There was no significant difference in intraoperative opioid consumption in both groups. Postoperative VAS score was insignificantly different at 0 h ,4 h, 8 h and 12 h in both groups. No significant difference was observed in intraoperative HR, MAP, SBP, DBP in both groups.

Conclusion: Immunonutrition has a substantial effect in lowering the rate of postoperative complications. However, it does not affect decreasing postoperative pain or length of hospital stay.

Keywords: Perioperative Supplementation; Immunonutrition, Outcome; Pain; Oral Cavity Tumors; Mandibular Tumors

Citation: Kotb TA, El Baradie SY, Abdelwahab M, Abed SM, Saeed S, Zedan MH, Thabet T. A randomized controlled trial of the impact of perioperative supplementation with immunonutrition on surgical outcome and pain in oral cavity or mandibular tumor resection. Anaesth. pain intensive care 2024;28(6):1010-1016;
DOI: 10.35975/apic.v28i6.2635

Received: May 23, 2024; Revised: October 14, 2024; Accepted: October 26, 2024