Hakim Karim Youssef Kamal, Wahba Wahba Zakaria Bekhet
Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Anesth Essays Res. 2019 Apr-Jun;13(2):199-203. doi: 10.4103/aer.AER_74_19.
Gynecological laparoscopic surgery is commonly performed on an ambulatory basis under general anesthesia. The postoperative quality of recovery (QOR) should be considered one of the principal endpoints after ambulatory surgery. Total intravenous anesthesia (TIVA) with opioids is known to improve postoperative QOR after ambulatory surgery. However, opioids can be associated with an increased incidence of postoperative complications, which can affect postoperative QOR. The primary aim of this study was to compare the patient recovery using the QOR-40 at 24 h postoperative in ambulatory gynecological laparoscopy between opioid-free (OF) TIVA and opioid-based TIVA.
A prospective, randomized, controlled, comparative study was conducted at the day surgery center.
Eighty females were included in the study. They were randomized into two equal groups: OF TIVA group with dexmedetomidine and propofol or opioid-based TIVA (O) group with fentanyl and propofol. The primary outcome was QOR-40 at 24 h postoperative, and the secondary outcomes were postoperative numerical rating scale (NRS), time to first rescue analgesia, number of rescue tramadol analgesia, and the incidence of postoperative nausea and vomiting.
A statistically significant difference in total QOR-40 score at 24 h postoperative was observed between the groups (median [range] QOR-40 of 182.0 [164.0-192.0] in the OF TIVA group and 170.0 [156.0-185.0] in the O group; = 0.03). OF group had significantly lower time to first rescue analgesia, maximum NRS pain scores, number of rescue tramadol analgesia, and ondansetron use.
OF TIVA significantly improves postoperative QOR in patients undergoing ambulatory gynecological laparoscopic surgery.
妇科腹腔镜手术通常在全身麻醉下以门诊手术的方式进行。术后恢复质量（QOR）应被视为门诊手术后的主要终点之一。已知使用阿片类药物的全静脉麻醉（TIVA）可改善门诊手术后的术后QOR。然而，阿片类药物可能与术后并发症发生率增加相关，这可能会影响术后QOR。本研究的主要目的是比较在门诊妇科腹腔镜手术中，无阿片类药物（OF）的TIVA与基于阿片类药物的TIVA在术后24小时使用QOR-40评估患者的恢复情况。
在日间手术中心进行了一项前瞻性、随机、对照、比较研究。
80名女性纳入研究。她们被随机分为两组：使用右美托咪定和丙泊酚的OF TIVA组，以及使用芬太尼和丙泊酚的基于阿片类药物的TIVA（O）组。主要结局是术后24小时的QOR-40，次要结局是术后数字评分量表（NRS）、首次补救镇痛时间、补救曲马多镇痛次数以及术后恶心呕吐的发生率。
两组之间在术后24小时的总QOR-40评分上观察到统计学上的显著差异（OF TIVA组的QOR-40中位数[范围]为182.0[164.0 - 192.0]，O组为170.0[156.0 - 185.0]；P = 0.03）。OF组的首次补救镇痛时间、NRS最大疼痛评分、补救曲马多镇痛次数和昂丹司琼使用量均显著更低。
OF TIVA显著改善了接受门诊妇科腹腔镜手术患者的术后QOR。
