Kim Seung Hyun, Ju Hyang Mi, Choi Chong-Hyuck, Park Hae Ri, Shin Seokyung
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2021 Feb 19;16(2):e0247089. doi: 10.1371/journal.pone.0247089. eCollection 2021.
Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA.
Sixty-eight patients, ASA class I or II who underwent corrective lower limb osteotomy were randomized to receive either desflurane anesthesia or propofol TIVA. The primary outcome was quality of recovery 40 (QoR-40) questionnaire scores on postoperative day (POD) 1 and 2. Postoperative nausea scores, antiemetic requirements, and amount of opioid consumption via intravenous patient-controlled analgesia (IV PCA) were assessed as secondary outcomes.
Global QoR-40 scores on POD 1 (153.5 (140.3, 171.3) vs. 140.0 (120.0, 173.0), P = 0.056, 95% CI; -22.5, 0.2) and POD 2 (155.5 (146.8, 175.5) vs. 152.0 (134.0, 179.0), P = 0.209, 95% CI; -17.5, 3.9) were comparable between the two groups. Among the five dimensions of QoR-40, physical independence scores were significantly higher in the TIVA group compared to the Desflurane group on POD both 1 and 2. Nausea scores (0.0 (0.0, 0.0) vs. 1.0 (0.0, 3.5), P < 0.001) and number of patients requiring rescue antiemetics (0% vs. 15.2%, P = 0.017) were significantly lower in the TIVA group at the post anesthesia care unit (PACU). Although the number of bolus attempts between 0-24 h and the morphine equivalent dose of analgesics administered via IV PCA between 12-24 h were significantly less in the TIVA group compared to the Desflurane group, there was no significant difference between groups for the overall 48 h postoperative period.
Propofol-based TIVA did not improve global QoR-40 scores compared with desflurane-based inhalational anesthesia. However, considering the better QoR-40 scores in the domain of physical independence and less nausea in the early postoperative period, propofol TIVA should be considered as a useful option in patients undergoing corrective lower limb osteotomy.
吸入麻醉和丙泊酚全静脉麻醉（TIVA）是全身麻醉最常用的两种方法，其各自独特的特性可能对恢复质量（QOR）产生不同影响。本研究比较了基于地氟烷的吸入麻醉和基于丙泊酚的TIVA用于下肢截骨矫形术后的恢复质量。
68例接受下肢截骨矫形术的ASA I或II级患者被随机分为接受地氟烷麻醉或丙泊酚TIVA组。主要结局指标为术后第1天和第2天的恢复质量40（QoR - 40）问卷评分。术后恶心评分、止吐药物需求以及通过静脉自控镇痛（IV PCA）的阿片类药物消耗量作为次要结局指标进行评估。
两组在术后第1天（153.5（140.3，171.3）对140.0（120.0，173.0），P = 0.056，95% CI： - 22.5，0.2）和第2天（155.5（146.8，175.5）对152.0（134.0，179.0），P = 0.209，95% CI： - 17.5，3.9）的总体QoR - 40评分相当。在QoR - 40的五个维度中，TIVA组在术后第1天和第2天的身体独立性评分均显著高于地氟烷组。在麻醉后恢复室（PACU），TIVA组的恶心评分（0.0（0.0，0.0）对1.0（0.0，3.5），P < 0.001）和需要急救止吐药物的患者数量（0%对15.2%，P = 0.017）显著更低。尽管TIVA组在0 - 24小时内的推注尝试次数以及在12 - 24小时内通过IV PCA给予的镇痛药吗啡等效剂量显著少于地氟烷组，但两组在术后48小时的总体情况无显著差异。
与基于地氟烷的吸入麻醉相比，基于丙泊酚的TIVA并未改善总体QoR - 40评分。然而，考虑到在身体独立性方面更好的QoR - 40评分以及术后早期较少的恶心情况，丙泊酚TIVA应被视为下肢截骨矫形术患者的一种有用选择。
