Perioperative Supplementation With Immunonutrition and Its Impact on Surgical Outcome and Pain in Oral Cavity or Mandibular Tumours

Not Applicable

Completed

Conditions: Immunonutrition
Surgical Outcome
Pain
Mandibular Tumor
Oral Cavity

Interventions: Dietary Supplement: Standard feeding
Dietary Supplement: Omega 3 and dipeptiven

Brief Summary: The aim of this study was to investigate the effect of adding omega 3 and dipeptiven to standard feeding in head and neck patients who will undergo oral cavity tumour resection or mandibular tumour resection (immunonutrrition mixture) on wound infection, fistula formation and length of hospital stay ,total dose of intraoperative and postoperative opioids (opioid consumption and pain incidence ,mortality and other postoperative complications as urinary tract infection (UTI) and pneumonia.

Detailed Description: Enhanced Recovery after Surgery (ERAS). A series of components that combine to minimize stress and to facilitate the return of function have been described: these include preoperative preparation and medication, fluid balance, anesthesia and postoperative analgesia, pre- and postoperative nutrition, and mobilization.

Nutrition therapy is the provision of nutrition or nutrients either orally (regular diet, therapeutic diet, e.g. fortified food, oral nutritional supplements) or via enteral nutrition (EN) or parenteral nutrition (PN) to prevent or treat malnutrition.

Head and neck cancer surgery usually means surgery to treat cancer of the mouth, throat or larynx . The surgery is complicated and people often experience problems such as wound infections and wound breakdown, as well as infections such as pneumonia.

The use of a nutritional supplement enriched with Omega 3 fatty acids is associated with a greater preoperative weight loss, reduced postoperative pain and decreased postoperative levels of C reactive protein in patients undergoing Roux-en-Y gastric bypass.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patient refusal and uncooperative patients.
Patient ASA III or IV.
Age more than 60 or less than 18.
Serum albumen less than 3.
Pre-existing severe malnourishment.
Allergy to test drugs.
Patients on tranquilizers, hypnotics, sedatives and other psychotropic patient on steroids and NSAID.

Arm && Interventions

Group	Intervention	Description
Group A (standard feeding)	Standard feeding	Patients received only standard feeding with caloric distribution (45%-50% carbohydrates,20-35% from fats and 10-35% from protein)
Group B (immunonutrition mixture)	Omega 3 and dipeptiven	Patients received perioperative supplementation with omega 3 and dipeptiven (immunonutrition mixture) plus standard feeding.

Primary Outcome Measures

Name	Time	Method
The incidence of wound infection	28 days after intervention	Evidence of redness and tenderness of surgical wound with discharge of pus was defined as a wound infection.

Secondary Outcome Measures

Name	Time	Method
The incidence of mortality	28 days after intervention	Mortality was measured postoperatively
Fistula formation	28 days after intervention	Fistula formation was measured postoperatively.
Length of hospital stay	28 days after intervention	Length of hospital stay was measured from admission discharge from hospital
Total dose of intraoperative opioids	Intraoperative	Total dose of intraoperative opioids was calculated in either group
Degree of pain	12 hours postoperative	Postoperative pain will be assessed by visual analogue scale (VAS) every 4 h. for 12 h. Patients reporting VAS score (more than 3) will receive rescue analgesics. VAS (0 represents "no pain" while 10 represents "the worst pain imaginable").
Total dose of postoperative opioids	12 hours postoperative	Total dose of postoperative opioids was calculated in either group
The incidence of complications	12 hours postoperative	Postoperative complications as urinary tract infection (UTI)and pneumonia.