Timing Of Nutrition In emergenCy laparotomy (TONIC)
Research type
Research Study
Full title
Timing Of Nutrition In emergenCy laparotomy (TONIC): A randomised trial comparing early parenteral nutrition vs standard nutritional care in adults undergoing emergency laparotomy.
IRAS ID
328678
Contact name
Matthew J Lee
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
2 years, 3 months, 29 days
Research summary
Emergency laparotomy is a major abdominal operation performed to treat life-threatening conditions such as infection, bowel blockage, or internal bleeding. These patients often struggle to eat and absorb nutrients after surgery, which can lead to poor recovery and complications. Emergency abdominal surgery, affects approximately 20,000 patients annually in England and Wales.
The TONIC trial is investigating whether starting intravenous nutrition (called parenteral nutrition or PN) within 48 hours of surgery can reduce complications compared to the usual approach, where nutrition is given later or through other methods.Currently, nutritional support is typically delayed until five days post-surgery, whether through high-energy drinks, nasogastric tubes, or PN. While early PN has shown promise in non-emergency settings, its effectiveness in emergency cases remains unclear due to additional complications like the need for specific blood test parameters and specialized venous access.
The trial will involve 898 adult patients across 25 UK hospitals, randomly assigned to two groups. The intervention group will receive PN within 48 hours of surgery, requiring special venous line placement and daily blood monitoring. The control group will receive standard care, which may include nutritional interventions after five days, or no nutritional intervention.
The research will compare surgical complications between groups at discharge, examining both severity and frequency. Follow-up will continue for 90 days, assessing quality of life, recovery, daily function, emergency readmissions within 30 days and cost-effectiveness.
Patient consent will be obtained pre-operatively, with information provided in multiple languages. For severely ill patients, personal consultee approval will be sought initially, followed by patient consent post-recovery.
The findings will help determine whether early nutritional intervention should be implemented as standard practice in emergency surgical cases and if the associated costs justify its adoption within the NHS.
REC name
East of England - Essex Research Ethics Committee
REC reference
25/EE/0268
Date of REC Opinion
14 Jan 2026
REC opinion
Further Information Favourable Opinion