Early Is Better: The Case for Immediate Hydration in Post-Surgery Pediatric Patients, finds study

Research on postoperative care for pediatric patients has traditionally emphasized extended fasting periods, typically between 3 to 6 hours. However, there has been a shift towards the exploration of early feeding or oral hydration, particularly in younger children undergoing elective surgeries. The significant findings of a recent randomized controlled trial indicate that early hydration within 30 minutes post-surgery resulted in improved patient satisfaction and lower discomfort, as measured by the Face, Legs, Activity, Cry, Consolability (FLACC) score, when compared to standard delayed hydration offered after two hours. During the trial, 66 children aged 1-5 years were randomized into two groups: those receiving early hydration (Group EH) and those receiving delayed standard hydration (Group SH). After excluding some participants based on predefined criteria, the final analysis encompassed 61 patients, ensuring demographic and perioperative characteristics were similar across groups. Both groups received standard analgesic care; however, early hydration significantly impacted the FLACC scores measured one hour after arrival at the post-anaesthesia care unit (PACU).

The early hydration group yielded a median FLACC score of 1 (range 0.25-2) contrasted with the delayed hydration group’s median score of 2 (range 1-3), indicating a notably lower level of discomfort (P = 0.028). Parental satisfaction was another critical focus of the study, with early hydration correlating to enhanced reported satisfaction rates. Evaluating satisfaction on a Likert scale, Group EH scored a median of 5 (range 4-5), while Group SH scored 4 (range 4-4), underscoring the favorable response from parents in the early hydration cohort (P < 0.001). Additionally, no major complications, such as significant vomiting, hypoxia, or other adverse effects, were noted in either group, signifying the safety of early hydration practices.

FLACC Score Utilization

A noteworthy aspect of this research is the utilization of the FLACC score as a proxy for patient satisfaction, particularly in preverbal children who cannot articulate their thirst or hunger. The application of behavioral indicators in assessing early hydration suggests a promising pathway towards optimizing pediatric postoperative care and enhancing recovery trajectories.

Literature and Recovery Strategies

Results from the trial resonate with recent literature advocating for shorter fasting periods and earlier oral intake, thus promoting more physiological postoperative recovery strategies. The findings suggest that enabling early hydration facilitates lower discomfort levels and reduced reliance on postoperative analgesics, providing benefits that extend beyond subjective measures to potential physiological advantages as well.

Study Limitations and Future Directions

While this study contributes valuable insights into the care of young surgical patients, it also highlights limitations such as the specificity of surgical types examined and the challenges related to measuring longer-term opioid consumption. Yet, it distinctly positions early postoperative hydration as a beneficial practice, warranting broader consideration in clinical settings not only to enhance patient satisfaction but also to embrace advancements in the management of pediatric postoperative care. Future studies may further investigate alternatives for hydration acceptance, including temperature considerations and additional factors influencing pediatric hydration response after general anesthesia.

Key Points

- Research highlights a shift from traditional fasting periods of 3 to 6 hours for pediatric patients post-surgery to early hydration within 30 minutes, especially for younger children undergoing elective surgeries, demonstrating improved outcomes.

- A randomized controlled trial involving 66 children aged 1-5 years examined early hydration (Group EH) vs. delayed hydration (Group SH), with the final analysis including 61 patients. Both groups had similar demographic and perioperative characteristics and received standard analgesic care.

- Measurements of discomfort using the Face, Legs, Activity, Cry, Consolability (FLACC) score indicated that the early hydration group had significantly lower levels of discomfort (median FLACC score of 1) compared to the delayed hydration group (median score of 2), with a statistically significant difference (P = 0.028).

- Parental satisfaction also improved with early hydration, as indicated by a higher median satisfaction score in Group EH (5) compared to Group SH (4), with this difference being statistically significant (P < 0.001).

- The study adhered to ethical guidelines, employing a single-blind design and randomization through sealed envelopes, ensuring unbiased outcome assessment by medical professionals.

- The findings are consistent with existing literature advocating for shorter fasting times and earlier oral intake, suggesting early hydration not only reduces discomfort and dependence on analgesics but also has potential physiological benefits, while also identifying study limitations such as specific surgical types and challenges in assessing longer-term opioid consumption. Future research may investigate additional factors affecting hydration responses in pediatric patients post-anesthesia.

Reference –

Mridul Dhar et al. (2025). Impact Of Early Postoperative Oral Hydration In Paediatric Patients Undergoing Elective Surgery After General Anaesthesia. A Randomised Controlled Trial. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_1127_24.