2019 CCS research highlights: Department of Anaesthesia and Perioperative Medicine - the RELIEF study

Professor Paul Myles, lead researcher on

the RELIEF study

Monash University's Central Clinical School is at the cutting edge of medical research in national and international arenas. We are publishing a series of our research highlights from across 2019.

In this article, we feature a highlight from the Department of Anaesthesia and Perioperative Medicine (APOM).

• Major international trial to benefit patients having major surgery

Each year, at least 310 million patients undergo major surgery worldwide in procedures that involve the administration of intravenous fluids.

Clinicians have traditionally delivered generous amounts of these fluids to patients both during and after surgery to correct for preoperative fasting, haemorrhage and to ensure adequate oxygen gets to tissue and that the output of urine is maintained. 

In abdominal surgery, administering intravenous fluid liberally can cause adverse effects such as oedema (swelling caused by excess fluid in tissue) and weight gain, meaning patients may stay longer in hospital. However, evidence about the effects of restricting fluid for patients undergoing major surgery is conflicting.

Professor Paul Myles, Head of the CCS Department of Anaesthesia and Perioperative Medicine, investigated.

The international Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of 3000 patients found patients on a restricted regimen experienced less disability-free survival compared to patients on a liberal one, and that they had a higher rate of acute kidney injury.

“These results surprised us and many other experts around the world. We now have clear evidence that moderately liberal intravenous fluids can protect the kidneys during major surgery,” Professor Myles said.

The study is one of a number conducted by Professor Myles and his Central Clinical School team aimed at reviewing and improving clinical practice globally.

See more detail in our 2018 feature.