Contemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women. This study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction. A randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized: 252 undergoing preoperative free access to water up to the call to dispatch to the operating theater (intervention group) and 252 undergoing fasting from midnight (fasting arm). The primary outcomes were perioperative vomiting and maternal satisfaction. Analyses were performed using test, Mann-Whitney test, and chi-square test, as appropriate. Of note, 9 of 252 patients (3.6%) in the intervention group and 24 of 252 patients (9.5%) in the control group had vomiting at up to 6 hours after completion of cesarean delivery (relative risk, 0.38; 95% confidence interval, 0.18–0.79; =.007), and the maternal satisfaction scores (0–10 visual numerical rating scale) were 9 (interquartile range, 8–10) in the intervention group and 5 (interquartile range, 3–7) in the control group (<.001). Assessed before dispatch to the operating theater, feeling of thirst was reported by 69 of 252 patients (27.4%) in the intervention group and 134 of 252 patients (53.2%) in the control group (relative risk, 0.52; 95% confidence interval, 0.41–0.65; <.001), capillary glucose levels were 4.8±0.7 mmol/L in the intervention group and 4.9±0.8 mmol/L in the control group (=.048), and preoperative intravenous fluid hydration was commenced in 49 of 252 patients (19.4%) in the intervention group and 76 of 252 patients (30.2%) in the control group (relative risk, 0.65; 95% confidence interval, 0.47–0.88; =.005). In the operating theater, ketone was detected in the catheterized urine in 38 of 252 patients (15.1%) in the intervention group and 78 of 252 patients (31.0%) in the control group (relative risk, 0.49; 95% confidence interval, 0.25–0.59; <.001), and the numbers of doses of vasopressors needed to correct hypotension were 2.3±1.7 in the intervention group and 2.7±2.2 in the control (=.009). The recommendation rates for preoperative oral intake regimen to a friend were 95.2% (240/252) in the intervention group and 39.7% (100/252) in the control group (relative risk, 2.40; 95% confidence interval, 2.06–2.80; <.001), in favor of free access to water. Other assessed maternal and neonatal outcomes were not different. Compared with fasting, free access to water in planned cesarean delivery reduced perioperative vomiting and was strongly favored by women. In addition, several pre- and intraoperative secondary outcomes were improved. However, postcesarean delivery recovery and neonatal outcomes were not different.

中文翻译：

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脊髓麻醉下计划剖宫产术前自由饮水与禁食的比较：一项随机对照试验

现代术前喂养指南允许在麻醉前 6 小时内进食固体食物，并在麻醉前 2 小时内进食清淡液体。缺乏支持这种剖腹产方法的临床试验证据。许多医生继续遵循保守的政策，即从午夜到手术期间不进食，尤其是孕妇。本研究旨在评估在脊髓麻醉下计划剖宫产的术前口服限制中允许自由饮水直至被送往手术室与从午夜禁食的实用方法对围手术期呕吐和产妇满意度的影响。 2020 年 10 月至 2022 年 5 月在马来亚大学医学中心产科进行了一项随机对照试验。共有 504 名计划剖腹产的参与者被随机分组​​：其中 252 名在术前免费喝水，直到接到调度通知为止前往手术室（干预组）和 252 名从午夜开始禁食的患者（禁食组）。主要结局是围手术期呕吐和产妇满意度。酌情使用检验、曼-惠特尼检验和卡方检验进行分析。值得注意的是，干预组 252 名患者中有 9 名 (3.6%) 和对照组 252 名患者中有 24 名 (9.5%) 在剖腹产完成后 6 小时内出现呕吐（相对风险，0.38；95% 置信区间） ，0.18–0.79；=.007），干预组的产妇满意度得分（0–10 视觉数字评分量表）为 9（四分位距，8–10），干预组为 5（四分位距，3–7）对照组（<.001）。在送往手术室之前进行评估，干预组 252 名患者中有 69 名患者 (27.4%) 报告口渴感，对照组 252 名患者中有 134 名患者 (53.2%) 报告口渴感（相对风险，0.52；95% 置信区间， 0.41–0.65；<.001），干预组毛细血管葡萄糖水平为 4.8±0.7 mmol/L，对照组为 4.9±0.8 mmol/L（=.048），49 例患者开始术前静脉补液干预组中有 252 名患者 (19.4%)，对照组有 252 名患者中的 76 名患者 (30.2%)（相对风险，0.65；95% 置信区间，0.47–0.88；=.005）。在手术室中，干预组 252 名患者中的 38 名患者 (15.1%) 和对照组 252 名患者中的 78 名患者 (31.0%) 的导管尿液中检测到酮（相对风险，0.49；95% 置信区间，0.25） –0.59；<.001），干预组纠正低血压所需的升压药剂量为 2.3±1.7 次，对照组为 2.7±2.2 次（=.009）。干预组向朋友推荐术前口服摄入方案的推荐率为 95.2% (240/252)，对照组为 39.7% (100/252)（相对风险，2.40；95% 置信区间，2.06-2.80； <.001），有利于免费获取水。其他评估的孕产妇和新生儿结局没有差异。与禁食相比，计划剖腹产时自由饮水可减少围手术期呕吐，受到女性的强烈青睐。此外，一些术前和术中的次要结果也得到了改善。然而，剖腹产后恢复和新生儿结局并无不同。