Newly Published
Perioperative Medicine  |   January 2020
Saline versus Lactated Ringer’s Solution: The Saline or Lactated Ringer’s (SOLAR) Trial
Author Notes
  • From the Department of General Anesthesiology (K.M., A.T., W.A.S.E., K.R., S.B., A.G.K., M.R.R., T.K., G.R.B., A.K.), Department of Outcomes Research (K.M., A.T., N.M., C.M., K.R., H.E., B.C., I.S., G.R.B., D.C., E.J.M., A.K., D.I.S.), Department of Quantitative Health Sciences (N.M., C.M., E.J.M.), and Department of Orthopedic Surgery (C.H.-R.), Cleveland Clinic, Cleveland, Ohio; the Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida (L.S.); the Division of Anesthesia, Critical Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (B.C.); and the Department of Anesthesia, St. Elizabeth’s Medical Center, Boston, Massachusetts (I.S.).
  • This article is accompanied by an editorial on p. XXX.
    This article is accompanied by an editorial on p. XXX.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • This work was presented at the American Society of Anesthesiologists Annual Meeting in Orlando, Florida, October 22, 2019.
    This work was presented at the American Society of Anesthesiologists Annual Meeting in Orlando, Florida, October 22, 2019.×
  • Submitted for publication June 4, 2019. Accepted for publication December 11, 2019.
    Submitted for publication June 4, 2019. Accepted for publication December 11, 2019.×
  • Correspondence: Address correspondence to Dr. Maheshwari: Departments of General Anesthesia and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue/E-31, Cleveland, Ohio 44195. MAHESHK@ccf.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Coagulation and Transfusion / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   January 2020
Saline versus Lactated Ringer’s Solution: The Saline or Lactated Ringer’s (SOLAR) Trial
Anesthesiology Newly Published on January 21, 2020. doi:https://doi.org/10.1097/ALN.0000000000003130
Anesthesiology Newly Published on January 21, 2020. doi:https://doi.org/10.1097/ALN.0000000000003130
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Infusion of large volumes of saline causes hyperchloremic metabolic acidosis

  • A recent Cochrane review based on 18 small trials reported that major morbidity and mortality were comparable with perioperative saline or lactated Ringer’s use

What This Article Tells Us That Is New:

  • In a large single-center alternating cohort trial of patients having elective colorectal or orthopedic surgery, there was no clinically meaningful difference in the risk of a composite of in-hospital mortality and major postoperative complications including renal, respiratory, infectious, and hemorrhagic complications

Background: Both saline and lactated Ringer’s solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer’s solution than normal saline.

Methods: The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer’s solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury.

Results: Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer’s solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer’s versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I–III versus 0, occurred in 6.6% of lactated Ringer’s patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful.

Conclusions: In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer’s or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.