Quality Of Recovery Score Research Articles

Association of menstrual cycle and postoperative quality of recovery in premenopausal women: a prospective cohort study.

Women have poorer quality of postoperative recovery from general anaesthesia than men. This persists for at least 3 days postoperatively, and is more pronounced in premenopausal women. Studies of menstrual cycle effects on pain or postoperative nausea and vomiting report conflicting results. Our aim was to determine whether menstrual cycle phase is associated with quality of recovery after surgery in premenopausal women. Eligible women aged 18-45 yr undergoing wisdom teeth extraction or laparoscopic cholecystectomy under general anaesthesia with volatile agents were recruited from Epworth HealthCare Richmond in Melbourne, Australia from 2019 to 2021. Menstrual history and progesterone levels were used to determine cycle phase (luteal or non-luteal). Linear mixed and generalised linear regression models were fitted to examine differences in Quality of Recovery-15 (QoR-15) score on postoperative days 1 (primary outcome) and 3, and secondary outcomes (pain, analgesic effectiveness, postoperative nausea and vomiting, prolonged hospital admission), between groups, adjusting for confounders. A total of 177 women were recruited (74 luteal, 103 non-luteal). Six (3%) underwent laparoscopic cholecystectomy. Estimated mean differences (95% confidence interval; P-value) in adjusted QoR-15 scores between luteal and non-luteal groups were -0.05 (-5.86 to 5.76; P=0.986) and 1.40 (-4.41 to 7.21; P=0.636) on postoperative days 1 and 3, respectively. Secondary outcomes were not different between groups. There was no significant difference in postoperative QoR-15 score or other outcomes between women in the luteal and non-luteal phases of their cycle. Women can be reassured that cycle phase does not impact postoperative quality of recovery when undergoing minor surgery under general anaesthesia. ACTRN12618000240246.

7547 Opioid-Sparing Versus Standard Postoperative Pain Regimen for Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

<h3>Study Objective</h3> This study investigated whether ICE-T, a multimodal opioid-sparing pain regimen using ice packs, acetaminophen (Tylenol), and ketorolac (Toradol) provided effective postoperative pain management compared with a standard pain regimen for total laparoscopic hysterectomy (TLH). <h3>Design</h3> This randomized controlled trial was designed to achieve over 90% power. Patients who underwent TLH were randomized to the ICE-T or standard pain regimen and outcomes were followed until postoperative day 4. <h3>Setting</h3> Intra-operatively patients were in dorsal lithotomy and Trendelenburg position. <h3>Patients or Participants</h3> Patients undergoing TLH for benign indications at the academic center from August 2019 until June 2021 were assessed for eligibility. Sixty-seven patients were enrolled preoperatively; 36 were randomized to the ICE-T regimen and 31 to the standard regimen. <h3>Interventions</h3> The ICE-T regimen prescribed around-the-clock ice-packs, acetaminophen and ketorolac. The standard protocol prescribed as needed ibuprofen and acetaminophen/oxycodone based on pain score. Both regimens included hydromorphone for breakthrough pain. These regimens were used inpatient and outpatient from post-anesthesia care unit discharge onwards. <h3>Measurements and Main Results</h3> Postoperative day 1 and 4 outcomes were evaluated using visual analog scales, validated Quality of Recovery Questionnaires, patient satisfaction scores, inpatient narcotic consumption and outpatient pain medication consumption. Patient and surgical demographics were evenly distributed. The median visual analog score and quality of recovery scores on postoperative day 1 were not significantly different; p=0.44 and p=0.85 respectively. However, the ICE-T arm median narcotic consumption on postoperative day 1 was significantly lower; 480.6 morphine milligram equivalents (MME) versus 619.2 MME, p=0.02. ICE-T arm postoperative day 4 median visual analog scores were also significantly lower in the per-protocol analysis (p=0.014). There were no significant differences in the postoperative day 4 median quality of recovery or satisfaction scores. <h3>Conclusion</h3> The ICE-T regimen is an effective multimodal opioid-sparing postoperative pain regimen for TLH. ICE-T has comparable pain control and patient satisfaction to the standard regimen while significantly decreasing narcotic consumption.

Quality of Recovery After Rotator Cuff Repair With Interscalene Liposomal Bupivacaine Versus Interscalene Nerve Catheter

Interscalene nerve catheters have been proven to be effective in managing pain after rotator cuff repair (RCR) surgery. Liposomal bupivacaine is a newer approved therapy for use around the interscalene brachial plexus, but its analgesic efficacy has limited supporting data in various patient populations. The purpose of this study was to investigate the quality of recovery after arthroscopic RCR in patients who received either single-injection interscalene liposomal bupivacaine or an interscalene peripheral nerve catheter. It was hypothesized that interscalene peripheral nerve catheters would provide more reliable analgesia and improved patient satisfaction 48 hours after surgery. Cohort study; Level of evidence, 2. Enrolled were 93 consecutive patients who underwent arthroscopic rotator cuff surgery at a single ambulatory surgery center between October 2020 and June 2021. Of these patients, 13 were lost to follow-up; thus, 80 patients were included in statistical analysis. One group of patients (n = 48) received a preoperative interscalene nerve block placed with 10 mL 0.5% bupivacaine and 10 mL 1.3% liposomal bupivacaine. The second group (n = 32) received a preoperative interscalene catheter with an initial bolus of 20 mL 0.25% bupivacaine and a 0.2% ropivacaine infusion by an elastomeric pump set at 10 mL/hr for 48 hours. The primary outcome was the difference between preoperative and 48-hour postoperative quality of recovery-15 (QoR-15) scores. Secondary outcomes included visual analog pain scores, opioid use, and patient satisfaction. Complications and adverse effects were also noted. The Kruskal-Wallis test was used to analyze means and standard deviations for continuous endpoints; Fisher exact test was used to analyze counts and proportions for categorical endpoints. The liposomal bupivacaine group had a mean reduction of 3.9 in their postoperative QoR-15 scores, and the catheter group had a mean reduction of 25.1 in their postoperative QoR-15 scores, indicating a significantly worse functional recovery period compared with liposomal bupivacaine within the first 48 hours (P < .001). Patients who received liposomal bupivacaine also had significantly lower pain scores on the second postoperative day, improved quality of sleep, and improved satisfaction with analgesia (P < .05 for all). The use of interscalene liposomal bupivacaine demonstrated significantly improved quality of recovery when compared with interscalene nerve catheter after RCR.

8715 Enhancing Quality of Recovery and Satisfaction in Minimally Invasive Gynecologic Surgery - Utility of Structured Perioperative Education

<h3>Study Objective</h3> Determine if additional structured perioperative education improves patient quality of recovery (QoR) and satisfaction in patients undergoing minimally invasive gynecologic surgery (MIGS). <h3>Design</h3> Two-phased quality improvement initiative. <h3>Setting</h3> Academic institution. <h3>Patients or Participants</h3> All patients undergoing MIGS with fellowship-trained surgeons. <h3>Interventions</h3> Patient educational video and informational handout. <h3>Measurements and Main Results</h3> Atotal of 126 patients received standard of care (SoC) counseling with their individual surgeon and 96 patients received standard of care plus additional education (SoC+E). Thirty SoC patients and 31 SoC+E patients met criteria. There were no significant differences in age, BMI, and duration of surgery between our two cohorts, however we observed longer duration of surgery in the SoC+E group. Approximately 75% of all cases were performed via multi-port laparoscopy. When examining our primary outcome, QoR between the cohorts was significantly different (p=0.03). Interestingly, while we hypothesized that QoR would be better in patients receiving additional education, the opposite was true in our study population. There were no significant differences when patients were asked to rate their recovery and preoperative counseling. Patient satisfaction did not differ between SoC and SoC+E groups with 80% and 74% as "very satisfied" in each cohort respectively. When patients in the SoC+E group were asked to rate the preoperative video and handout, 45% of patients and 32% of patients "strongly agreed" and "agreed" that the video was helpful, respectively. <h3>Conclusion</h3> Current literature supports the safety and feasibility of same-day-discharge in MIGS. This places the patient in a unique position to self-manage their recovery at home. There is a paucity of data suggesting ways to actually enhance peri-operative counseling beyond individual surgeon counseling (SoC). We demonstrate a significant difference between QoR scores. Interestingly, those who only received surgeon counseling demonstrated higher QoR scores. Additional studies are needed to determine effective tools that will serve as an adjunct to each surgeon's standard of care

Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial

BackgroundModified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface. The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC).MethodThe present study was designed as a double-blind, randomized, controlled, prospective study. A total of 68 patients were included in the study. In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia. No block was performed on the group control. The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded.ResultsPain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results.ConclusionAfter the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.

Effect of transversus abdominis plane block on the quality of recovery in laparoscopic nephrectomy: A prospective double-blinded randomized controlled clinical trial.

Background:Poorly controlled acute postoperative pain after laparoscopic nephrectomy may adversely affect surgical outcomes and increase morbidity rates. In addition, excessive use of opioids during surgery may slow postoperative endocrine and metabolic responses and cause opioid-related side effects and opioid-induced hyperalgesia. The purpose of this study was to evaluate the effect of ultrasound-guided transversus abdominis plane (TAP) block on the postoperative quality of recovery and intraoperative remifentanil requirement in laparoscopic nephrectomy.Methods:Sixty patients who underwent laparoscopic nephrectomy were randomly divided into 2 groups: TAP and Control groups. After induction of anesthesia and before awakening from anesthesia, the TAP group was administered 40 mL of 0.375% ropivacaine and the Control group was administered 40 mL of normal saline to deliver ultrasound-guided TAP block using 20 mL of each of the above drugs. The main objectives of this study were to evaluate the effect of the TAP block on quality of recovery using the Quality of Recovery 40 (QoR-40) questionnaire and assessments of intraoperative remifentanil requirement. In addition, to evaluate the postoperative analgesic effect of the TAP block, the total usage time for patient-controlled analgesia (PCA) and the number of PCA bolus buttons used in both groups were analyzed.Results:The QoR-40 score, measured when visiting the ward on the third day after surgery, was significantly higher in the TAP group (171.9 ± 23.1) than in the Control group (151.9 ± 28.1) (P = .006). The intraoperative remifentanil requirement was not significantly different between the groups (P = .439). In the TAP group, the frequency of bolus dose accumulation at 1, 2, 3, 6, 12, 24, 48, and 72 hours after surgery was low enough to show a significant difference, and the total usage time for PCA was long enough to show a significant difference.Conclusion:In conclusion, we determined that ultrasound-guided TAP block during laparoscopic nephrectomy improves the quality of postoperative recovery and is effective for postoperative pain control but does not affect the amount of remifentanil required for adequate anesthesia during surgery.

Effect of Erector Spinae Plane Block on Postoperative Pain after Laparoscopic Colorectal Surgery: A Randomized Controlled Study.

The erector spinae plane (ESP) block can be used to reduce pain and opioid requirements after abdominal surgery. We evaluated the effect of the ESP block on postoperative pain score, analgesic use, and quality of recovery (QoR) score in patients undergoing laparoscopy. Fifty-nine patients undergoing elective laparoscopic colorectal surgery were randomly assigned to control (n = 30) or ESPB (n = 29) groups after anesthesia induction. In the ESPB group, an ultrasound-guided ESP block was performed immediately after induction using 20 mL of 0.5% ropivacaine bilaterally. The primary outcome was the postoperative pain score, which was evaluated using the 11-point numeric rating scale (NRS) (0 = no pain, 10 = worst imaginable pain), in the recovery room. NRS “at rest” and “on cough” and total dose of fentanyl rescue (in the recovery room) as well as NRS “at rest” and the cumulative administered fentanyl dose of patient-controlled analgesia (24 h post-surgery) were significantly lower in the ESPB group than in the control group. The postoperative QoR score did not differ between the groups. Bilateral ESP block after induction reduced pain scores and opioid requirements for 24 h postoperatively but did not improve the QoR in patients undergoing laparoscopic colorectal surgery.

The effect of newly designed dual-channel elastomeric pump for intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study

BackgroundA newly designed intravenous patient-controlled analgesia (PCA) device with a dual-channel elastomeric infusion pump has been recently introduced. One channel is a continuous line with a constant flow rate basal infusion, while the other channel has an adjustable flow rate and bolus function and is labeled as a selector-bolus channel. This study compared dual and single-channel intravenous PCA in terms of clinical effect and quality of recovery.MethodsEighty-four patients undergoing total laparoscopic hysterectomy were randomly allocated to a 1-channel group (n = 41) or a 2-channel group (n = 43). Only the selector-bolus channel was utilized, but the continuous channel was not utilized in the 1-channel group, but both channels were utilized in the 2-channel group. In the 1-channel group, 16 μg/kg of fentanyl, 2 mg/kg of ketorolac, and 12 mg of ondansetron with normal saline were administered to the selector-bolus channel and normal saline only in the continuous channel for blinding. In the 2-channel group, 16 μg/kg of fentanyl was administered to the selector-bolus channel, and ketorolac (2 mg/kg) and ondansetron (12 mg) were administered via the continuous channel.The quality of recovery was evaluated preoperatively and 24 h postoperatively using the Quality of Recovery-40 (QoR-40). Cumulative PCA consumption, postoperative pain rated using the numeric rating scale (NRS; during rest/cough), and postoperative nausea were evaluated 6, 12, 24, 36, and 48 h after surgery. Incidence of vomiting and use of antiemetics and rescue analgesics was measured.ResultsThe 24-h postoperative QoR-40 score was higher in the 2-channel group than in the 1-channel group (P=0.031). The incidence of nausea at 12 h and 36 h was significantly higher in the 1-channel group (P=0.043 and 0.040, respectively), and antiemetic use was more frequent in the 1-channel group (P=0.049). Patient satisfaction was higher in the 2-channel group (P=0.036). No significant differences were observed in pain scores during resting/cough or cumulative PCA consumption.ConclusionsThe 2-channel PCA showed better patient satisfaction with higher QoR-40 during the recovery compared with the 1-channel PCA. Better satisfaction was associated with lower nausea and reduced rescue antiemetics by maintaining the infusion of adjuvant analgesic agents and antiemetic agents constantly by utilizing dual channels.Trial registrationRegistered at ClinicalTrials.gov, NCT04082039 on 9 September 2019.

Intraoperative administration of systemic/epidural/intrathecal morphine on the quality of recovery following substitutional urethroplasty with buccal mucosal graft: A randomized control trial.

Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting. This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared. Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185-191), 189 (187-191), and 185 (183-189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group. All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.

Effects of different anesthetic depth during propofol anesthesia on postoperative recovery 24h after arthroscopic day surgery: A randomized clinical trial.

Background: This study aimed to compare the effects of different depths of sedation during propofol anesthesia on postoperative recovery 24 h after knee arthroscopy day surgery in adult patients. Methods: This prospective randomized controlled trial involved 126 patients (ASA physical status 1–2) who were scheduled to undergo arthroscopic day surgery. Patients were randomly divided into two groups: the light-sedation (L-Group) or deep-sedation (D-Group). In the L-group, the bispectral index values were kept in the range of 50–59; in the D-group, the bispectral index values were maintained in the range of 40–49. The Quality of Recovery-15 (QoR-15) score assessed 24 h postoperatively using a 15-item questionnaire was the primary outcome. Secondary outcomes included Athens Insomnia Scale scores, postoperative pain scores, nausea or vomiting. Results: The total QoR-15 score 24 h postoperatively was similar in the two groups (L-group median:130, IQR [127–132] vs. D-group median:131, IQR [126–135], p = 0.089). But among the five dimensions of the QoR-15, physiological comfort was significantly better in the D-group than L-group (p < 0.001). The time to open eyes (p < 0.001), follow the command (p < 0.001) and to extubation (p < 0.001) after surgery in the L-group were shorter than the D-group. The Athens Insomnia Scale scores (p < 0.001) and incidence of dreaming (p = 0.041) at the first postoperative night in the L-group was significantly higher than those in the D-group. Propofol consumption in the L-group was less than D-group (p < 0.001). Conclusion: For patients undergoing arthroscopic day surgery, general anesthesia with high-bispectral-index (50–59) cannot improve the total QoR-15 score 24 h postoperatively after surgery, but can lessen propofol consumption, reduce the time of extubation and anesthesia recovery period, compared with low-bispectral-index (40–49). Patients exposed to general anesthesia with low-bispectral-index values (40–49) may have better quality sleep and physical comfort than those with high-bispectral-index values (50–59). Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=126526, identifier ChiCTR2100046340

Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebral block after minimally invasive thoracic surgery: a prospective, randomised controlled trial

BackgroundPROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) guidelines recommend erector spinae plane (ESP) block or paravertebral block (PVB) for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). However, there are few trials comparing the effectiveness of these techniques on patient-centric outcomes, and none evaluating chronic postsurgical pain (CPSP). Furthermore, there are no available trials comparing ultrasound-guided ESP with surgically placed PVB in this patient cohort. MethodsWe conducted a two-centre, prospective, randomised, double-blind, controlled trial, comparing anaesthesiologist-administered, ultrasound-guided ESP catheter with surgeon-administered, video-assisted PVB catheter analgesia among 80 adult patients undergoing VATS. Participants received a 20 ml bolus of levobupivacaine 0.375% followed by infusion of levobupivacaine 0.15% (10–15 ml h−1) for 48 h. Primary outcome was Quality of Recovery-15 score (QoR-15) at 24 h. Secondary outcomes included QoR-15 at 48 h, peak inspiratory flow (ml s−1) at 24 h and 48 h, area under the pain verbal response score vs time curve (AUC), opioid consumption, Comprehensive Complication Index, length of stay, and CPSP at 3 months after surgery. ResultsMedian (25–75%) QoR-15 at 24 h was higher in ESP (n=37) compared with PVB (n=37): 118 (106–134) vs 110 (89–121) (P=0.03) and at 48 h: 131 (121–139) vs 120 (111–133) (P=0.03). There were no differences in peak inspiratory flow, AUC, Comprehensive Complication Index, length of hospital stay, and opioid consumption. Incidence of CPSP at 3 months was 12 (34%) for ESP and 11 (31%) for PVB (P=0.7). ConclusionsCompared with video-assisted, surgeon-placed paravertebral catheter, erector spinae catheter improved overall QoR-15 scores at 24 h and 48 h but without differences in pain or opioid consumption after minimally invasive thoracic surgery. Clinical trial registrationNCT04729712.

The effect of aggressive management of intraoperative body temperature on postoperative APACHE II score and prognosis in high-risk patients undergoing thoracoscopic surgery.

BackgroundIntraoperative hypothermia is related with postoperative complication, longer length of stay (LoS) and mortality. Acute Physiology and Chronic Health Evaluation II (APACHE II) it the most commonly used evaluation system for assessing the severity and clinical prognosis of patients. This study sought to examine the effect of intraoperative body temperature on postoperative APACHE II scores and the prognosis of high-risk patients undergoing thoracoscopic surgery.MethodsThis study used the clinical data of patients from a multicenter randomized controlled trial who had undergone thoracoscopic surgery at our center (NCT03111875). In our center were randomly assigned (1:1) to receive either aggressive warming to a target core temperature of 37 ℃ or routine thermal management to a target of 35.5 ℃ during non-cardiac surgery. Randomisation was computer-generated. Eligible patients (aged ≥45 years) had at least one cardiovascular risk factor, were scheduled for inpatient noncardiac surgery expected to last 2–6 h with general anaesthesia. We retrieved medical information through the electronic medical record system. The primary outcome was the postoperative APACHE II scores, APACHE II score variation. The secondary outcome was Quality of Recovery-15 (QoR-15) scores, LoS in hospital, postoperative complications, infections, and deaths of the patients were recorded, and a logistic regression analysis was conducted to stratify the risk factors for the APACHE II score.ResultsGroup R comprised 121 patients and Group A comprised 84 patients. Group A had lower postoperative APACHE II scores (P=0.046) and a lower probability of a grade increase than Group R (P=0.005). However, no significant differences were found in terms of the QoR-15 scores, LoS, postoperative complications, infections, and deaths between the 2 groups. The logistic regression showed that aggressive warming, age, and the American Society of Anesthesiologists (ASA) grade were risk factors for the deterioration of postoperative APACHE II scores.ConclusionsThe active adoption of various passive and aggressive warming strategies to keep the core body temperature ≥37 ℃ during thoracoscopic surgery significantly reduced increases in APACHE II scores, which is different from age and ASA grade, and was the only intervention factor.

Effect of a patient education video and prehabilitation on the quality of preoperative person-centred coordinated care experience: protocol for a randomised controlled trial

IntroductionMultimodal prehabilitation, an emerging field within the Perioperative Medicine specialty, requires close multidisciplinary team coordination. The goal is to optimise the patient’s health status in the 4–8 weeks before elective...

Efficacy of single-shot adductor canal block before Versus after primary total knee arthroplasty - Does timing make a difference? A randomized controlled trial.

Total knee arthroplasty (TKA) is associated with severe postoperative pain. Multimodal analgesia, including peripheral nerve block, is recommended for post-operative pain relief. Administration of some pain medications prior to surgery has shown to be more effective than after the operation. This is a prospective, randomized controlled trial designed to compare the analgesic efficacy of the adductor canal block (ACB) performed immediately before or immediately after primary total knee arthroplasty (TKA). We hypothesized that ACB before the surgery will reduce postoperative pain and improve knee function. A total of 50 patients were enrolled and randomized into 2 groups, with 26 patients receiving a preoperative ACB and 24 receiving a postoperative ACB. Treatment groups were similar in terms of gender (p = .83), age (p = 0.61) weight (p = .39) and ASA score. Average visual analogue scale (VAS) on arrival to the post-anesthesia care unit (PACU) were 4.9 ± 3.2 in the preoperative ACB versus 3.4 ± 2.8 for the postoperative ACB (p = .075). VAS scores at different time points as well as the mean, minimal and maximal reported VAS scores were not significantly different between the two groups. The cumulative quantities of Fentanyl administered by the anesthesia team was comparable between the groups. Similarly, the dosage of Morphine, Tramadol, Acetaminophen and Dipyrone showed only small variations. The Quality of Recovery Score, Knee Society Scores and knee range of motion did not differ between the groups. Our findings demonstrate no significant differences in patient total narcotics consumption, pain scores and functional scores, between preoperative and postoperative ACB in patients undergoing TKA. The trial was registered at www.clinicaltrials.gov and was assigned the registration number NCT02908711. level I randomized controlled trial.

Impact of analgesic techniques on early quality of recovery after prostatectomy: A 3-arm, randomized trial.

BackgroundProstatectomy is associated with relevant acute postoperative pain. Optimal analgesic techniques to minimize pain and enhance recovery are still under investigation. We aimed to compare the effect of three different analgesic techniques on quality of recovery.MethodsThis investigator‐initiated, prospective, randomized, three‐arm, parallel‐group, active‐controlled, interventional superiority trial was performed in a Swiss teaching hospital from 2018 to 2021. Consecutive patients undergoing open or robotic‐assisted radical prostatectomy were randomized to spinal anaesthesia (SSS, bupivacaine 0.5% + fentanyl), bilateral transversus abdominis plane block (TAP, ropivacaine 0.375% + clonidine) or systemic administration of lidocaine (SA, lidocaine 1%) in addition to general anaesthesia. Primary outcome was quality of recovery 15 (QoR‐15) score on postoperative day one compared to baseline. Secondary outcomes were QoR‐15 at discharge, postoperative nausea and vomiting, pain scores, return of gastrointestinal function and use of rescue analgesia.ResultsFrom 133 patients, 40 received spinal anaesthesia, 45 TAP block and 48 systemic analgesia. QoR‐15 scores did not differ on day 1 (p = 0.301) or at discharge (p = 0.309) when compared to baseline. QoR‐15 changes were similar in all groups. At discharge, median QoR‐15 scores were considered as good (>122) in all groups: SSS 134 [IQR 128–138]; TAP 129 [IQR 122–136] and SA 128 [IQR 123–136]. There were no significant differences in the other secondary outcomes.ConclusionsQuality of recovery on postoperative day one compared to baseline did not differ if spinal anaesthesia, TAP block or systemic administration of lidocaine was added to general anaesthesia.SignificanceOptimal analgesic techniques to enhance recovery after prostatectomy are still under investigation. In this 3‐arm randomized controlled trial, addition of spinal anaesthesia or transversus abdominis plane block to general anaesthesia did not improve quality of recovery after radical prostatectomy compared to less invasive intravenous lidocaine infusion (standard of care/control group). Quality of recovery at the time of discharge was considered as good in all three groups.

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial.

PurposeOpioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy.Patients and MethodsSeventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels.ResultsThe patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group (p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group (p = 0.002).ConclusionOFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

HERO-Trial: Integration of self-hypnosis in an enhanced recovery after surgery program: A prospective randomized trial (115)

<b>Objectives:</b> Self-hypnosis (SH) induces patients into a relaxed state that may include feelings of dissociation through deep breathing and guided imagery. Studies have shown that SH can reduce patient distress prior to surgery and postoperative pain and anxiety. We evaluated whether adding SH to our enhanced recovery after surgery (ERAS) pathway was feasible and if it could improve patient-reported pain and anxiety and further decrease opioid use. <b>Methods:</b> Patients scheduled for open gynecologic surgery were randomized to either standard ERAS care or ERAS + SH. The 20-minute, 3D, SH audio recording was based on a well-validated medical hypnosis script. Patients in the SH arm were asked to listen to the audio file at least twice before surgery, although they had access to use it ad-lib after consent. The feasibility endpoint was defined as 60% of patients listening to the entire SH audio file in the preoperative holding area. The primary effectiveness outcome was worst pain on POD 1 (24-hour recall) on a 0-10 scale, assessed with the MDASI-PeriOpGYN. Secondary outcomes included anxiety, quality of life, symptom burden, time to the first opioid, quality of recovery (QoR-15), and morphine equivalent daily dose (MEDD) on POD 0-3. Hypnotic suggestibility was assessed by the Tellegen Absorption scale. Expectations and manageability of postoperative symptoms were assessed by the Side-Effect Expectancy Questionnaire (SEEQ). Satisfaction with the SH experience was evaluated. Summary statistics, Fisher's exact test (categorical variables), and Wilcoxon rank-sum test (continuous variables) were utilized. <b>Results:</b> A total of 152 patients were randomized and 138 had surgery and were evaluable (ERAS: <i>n</i> = 67; ERAS+SH: <i>n</i> = 71) (Table 1). Incorporation of SH was considered feasible, with 77.5% of ERAS+SH patients able to listen to the entire SH audio file in the preoperative holding unit. The study was stopped early due to futility in achieving the primary effectiveness outcome (pain on POD1). There were no significant differences in the primary outcome of worst pain on POD 1 (ERAS: 6/10; ERAS+SH: 7/10) (p=.70). The median age was 61 years in the ERAS arm and 54 years in the ERAS+SH arm (Table 1 for demographics). There were no significant differences in ERAS compliance, anesthesia type, or length of stay. No significant differences between the groups were noted on expectations, perceived ability to manage postoperative symptoms or hypnotic suggestibility. Median scores on the five satisfaction questions were 8/10 or above. There were no differences in median preoperative anxiety scores between the arms (ERAS: 4, IQR: 1-6; ERAS+SH: 4, IQR: 3-7). In the ERAS+SH arm, anxiety scores decreased significantly after the SH intervention in the preoperative holding unit -2 points (IQR:-3,-1) to a median score of 2 (p<.001). There were no significant differences in median MEDD on POD 0-3 between the two arms (daily median MEDD ranged from 0-15) or time to the first opioid. The quality of recovery score on the day of discharge was not significantly different between groups (ERAS: 110, IQR: 92-127; ERAS+SH: 107, IQR: 88-121). <b>Conclusions:</b> Incorporating SH into an ERAS pathway was feasible with high levels of satisfaction. While the SH intervention led to a statistically and clinically significant decrease in self-reported anxiety levels preoperatively, there were no group differences in self-reported pain, quality of recovery, time to the first opioid, or hospital MEDD. Given the ease of accessing and listening to an audio file, this SH intervention can be easily integrated into perioperative care to decrease preoperative anxiety.

Effect of Scalp Nerve Block Combined with Intercostal Nerve Block on the Quality of Recovery in Patients with Parkinson's Disease after Deep Brain Stimulation: Protocol for a Randomized Controlled Trial.

Background: Parkinson’s disease (PD) patients who receive deep brain stimulation (DBS) have a higher risk of postoperative pain, which will affect their postoperative quality of recovery (QoR). Scalp nerve block (SNB) and intercostal nerve block (ICNB) can alleviate postoperative pain, yet their effect on postoperative QoR in PD patients has proven to be unclear. Therefore, we have aimed to explore the effect of SNB paired with ICNB on postoperative QoR. Methods: To explore the effect, we have designed a randomized controlled trial in which 88 patients with PD will be randomly assigned to either an SNB group or control group, receiving either SNB combined with ICNB or without before surgery. The primary outcome will be a 15-item QoR score at 24 h after surgery. The secondary outcomes will include: 15-item QoR scores at 72 h and 1 month after surgery; the numeric rating scale pain scores before discharge from the postanesthesia care unit (PACU) at 24 h, 72 h, and 1 month after surgery; rescue analgesics; nausea and vomiting 24 h after operation and remifentanil consumption during operation; emergence agitation; the duration of anesthesia and surgery; time to respiratory recovery, time to response, and time to extubation; the PACU length of stay; as well as adverse events. Proposed protocol and conclusion: Our findings will provide a novel method for the management of recovery and acute pain after DBS in PD patients. This research was registered at clinicaltrials.gov NCT05353764 on 19 April 2022.

Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block

BackgroundModified radical mastectomy (MRM) is the most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain and even lasts for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.MethodsIn this randomized controlled trial, eighty female breast cancer patients undergoing unilateral MRM with sentinel lymph node dissection (SLND) and axillary dissection (ALND) were enrolled. Patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n = 40) or TPVB (TPVB group, n = 40) with 0.5% ropivacaine 30 ml. Evaluated variables included 24 h postoperative total PCA fentanyl consumption, including PCA background consumption and PCA press consumption (per bolus dosage multiply by the effective pressing times), and intraoperative fentanyl consumption, as well as postoperative flurbiprofen axetil requirement, duration of analgesia, blocking area, pain intensity at rest and during activity, ability to reduce the inflammatory response, and the quality of recovery 40 (QoR-40) score of patients.ResultsCompared with the TPVB, the main blocking area was T2–T6 in the TTP-PECS group, which was more suitable for the MRM. TTP-PECS has a longer analgesia duration than TPVB; 24 h postoperative total PCA fentanyl consumption, especially the PCA press consumption, and the postoperative flurbiprofen axetil requirement were decreased in the TTP-PECS group than those in the TPVB group. Furthermore, the VAS scores at rest and during activity and inflammatory response were lower in the TTP-PECS group compared with the TPVB group at 12 h postoperatively. Finally, the total QoR-40 score, especially for the scores of pain; emotional state; and patient support were better in the TTP-PECS group.ConclusionCompared with the TPVB, TTP-PECS can provide better postoperative analgesia in patients undergoing MRM, simultaneously reduce the inflammatory response, and prompt early recovery. These results suggest that TTP-PECS is an attractive alternative to TPVB for postoperative analgesia of modified radical mastectomy.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist