Patients lose a significant amount of muscle following major abdominal surgery. This is partly due to a catabolic response to the surgical insult and inflammation, but is also probably due to a lack of muscle use secondary to immobility. This study will aim to assess whether some or even all of postoperative muscle loss in the upper leg muscle group is preventable through electrical muscle stimulation to mimic physical activity.
Following major gastrointestinal surgery patients may loose around 6 % of their skeletal muscle mass in the first 5 days. Whilst some of this loss is as a result of inflammation and starvation, some is due to muscle disuse. Studies have shown that patients spend 96% of their time being sedentary in the first 5 days following major abdominal surgery and by day 5 are still taking a median of less than 500 steps per day. Studies of healthy volunteers who undergo similar muscle disuse loose approximately 3.5% of skeletal muscle mass over the same time period, indicating that around half of postoperative muscle loss may be due to immobility. Through the use of electrical muscle stimulation, this study will aim to mimic high levels of exercise in the quadriceps of patients who have undergo major gastrointestinal surgery to see whether this reduces or prevents muscle loss. Patients muscles will be measured using ultrasound and DXA and neuromuscular function will be measured using electromyography.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
SINGLE
Enrollment
20
Electrical muscle stimulation
Royal Derby Hospital
Derby, Derbyshire, United Kingdom
RECRUITINGVastus Lateralis muscle thickness (cm)
Ultrasound scan (USS) measurement of Vastus Lateralis muscle thickness in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Vastus Lateralis muscle fibre length
USS measurement of Vastus Lateralis muscle fibre length in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Vastus Lateralis muscle fibre pennation angle
USS measurement of Vastus Lateralis muscle fibre pennation angle in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Compound muscle action potentials (CMAP) as measured by surface electromyography
Changes in compound muscle action potentials (as detected by EMG) in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Near Fibre Motor Unit Potentials as measured by surface EMG
Changes in motor unit potentials (as detected by EMG) in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Motor unit number estimates ((MUNE) as derived from surface EMG analysis)
Changes in MUNE (as derived from surface EMG) in stimulated vs non stimulated legs of postoperative patients
Time frame: 5 days
Lean muscle mass
DXA measurements of lean muscle mass in upper leg of stimulated vs non stimulated legs of postoperative patients
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Time frame: 5 days
Physical activity levels in postoperative patients
Physical activity levels of patients following major gastrointestinal resection surgery on each postoperative day as measured by physical activity monitor
Time frame: 5 days
Dietary intake in postoperative patients
Dietary intake of patients following major gastrointestinal resection surgery, as recorded by patient food diary on each postoperative day
Time frame: 5 days
Inflammatory response following major abdominal surgery
Inflammatory response (as measured by IL6, TNFalfa and CRP) following major gastrointestinal resection surgery and its correlation with degree of skeletal muscle loss
Time frame: 5 days
Acceptability of electrical muscle stimulation in postoperative patients
Patient experience of electrical muscle stimulation following major gastrointestinal resection surgery as measured by visual analogue score measures of patient comfort, distress, harmful effects and enjoyment.
Time frame: 5 days