Quality of Recovery from Anesthesia in Neurosurgical Patients

Background Factors influencing quality of recovery in cranial and spinal neurosurgical patients are not known, possibly because of lack of a suitable instrument. Therefore, the authors measured quality of recovery using the QoR-40 score (a 40-item questionnaire on quality of recovery from anesthesia). Methods With informed consent, 200 patients undergoing elective neurosurgery were recruited. The QoR-40 score, visual analog scores for pain and quality of recovery, and data on complications were collected over 90 days. The psychometrics of the QoR-40 were tested and regression models were developed to determine predictors of quality of recovery and postoperative pain. Results The QoR-40 score demonstrated significant responsiveness, validity, and reliability. In cranial surgery patients, QoR-40 scores were lower on days 1 and 2 than either preoperatively or on days 3, 30, and 90. In spinal surgery patients, QoR-40 scores were lower preoperatively and on days 1 and 2 than on days 3, 30, and 90. Longer duration of surgery, more complications, and higher visual analog scores for pain were predictors of poor quality of recovery on day 3. Cranial surgery patients had moderately severe pain on days 1 and 2, whereas spinal surgery patients reported moderate pain for the whole study period. Neurologic deficits were negatively correlated with QoR-40 scores in cranial and spinal surgery patients. Conclusions The QoR-40 score is a useful instrument with which to assess quality of recovery in cranial and spinal surgery patients. Postoperative pain and neurologic deficits correlate with poor quality of recovery in these patients.

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Quality of Recovery From Anesthesia in Neurosurgical Patients

Survey of Anesthesiology ◽

10.1097/01.sa.0000140530.61191.35 ◽

2004 ◽

Vol 48 (5) ◽

pp. 234

Author(s):

Rebecca Fanning ◽

Anthony J. Cunningham

Keyword(s):

Quality Of Recovery ◽

Neurosurgical Patients ◽

Recovery From Anesthesia

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Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study

Journal of Neurosurgery ◽

10.3171/2015.10.jns151516 ◽

2016 ◽

Vol 125 (6) ◽

pp. 1513-1522 ◽

Cited By ~ 22

Author(s):

Nir Shimony ◽

Uri Amit ◽

Bella Minz ◽

Rachel Grossman ◽

Marc A. Dany ◽

...

Keyword(s):

Postoperative Pain ◽

Sleep Quality ◽

Rating Scale ◽

Preoperative Anxiety ◽

Controlled Study ◽

Double Blind ◽

Analgesic Consumption ◽

Pain Scores ◽

Neurosurgical Patients ◽

Duration Of Surgery

OBJECTIVE The aim of this study was to assess in-hospital (immediate) postoperative pain scores and analgesic consumption (primary goals) and preoperative anxiety and sleep quality (secondary goals) in patients who underwent craniotomy and were treated with pregabalin (PGL). Whenever possible, out-of-hospital pain scores and analgesics usage data were obtained as well. METHODS This prospective, randomized, double-blind and controlled study was conducted in consenting patients who underwent elective craniotomy for brain tumor resection at Tel Aviv Medical Center between 2012 and 2014. Patients received either 150 mg PGL (n = 50) or 500 mg starch (placebo; n = 50) on the evening before surgery, 1.5 hours before surgery, and twice daily for 72 hours following surgery. All patients spent the night before surgery in the hospital, and no other premedication was administered. Opioids and nonsteroidal antiinflammatory drugs were used for pain, which was self-rated by means of a numerical rating scale (score range 0–10). RESULTS Eighty-eight patients completed the study. Data on the American Society of Anesthesiologists class, age, body weight, duration of surgery, and intraoperative drugs were similar for both groups. The pain scores during postoperative Days 0 to 2 were significantly lower in the PGL group than in the placebo group (p < 0.01). Analgesic consumption was also lower in the PGL group, both immediately and 1 month after surgery. There were fewer requests for antiemetics in the PGL group, and the rate of postoperative nausea and vomiting was lower. The preoperative anxiety level and the quality of sleep were significantly better in the PGL group (p < 0.01). There were no PGL-associated major adverse events. CONCLUSIONS Perioperative use of twice-daily 150 mg pregabalin attenuates preoperative anxiety, improves sleep quality, and reduces postoperative pain scores and analgesic usage without increasing the rate of adverse effects. Clinical trial registration no.: NCT01612832 (clinicaltrials.gov)

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Oxidative Stress Parameters after Abdominal Hysterectomy and Their Relationships with Quality of Recovery

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2017-0046 ◽

2019 ◽

Vol 20 (2) ◽

pp. 27-36 ◽

Cited By ~ 3

Author(s):

Danijela Jovanovic ◽

Dragan R. Milovanovic ◽

Nevena Jeremic ◽

Tamara Nikolic ◽

Isidora Stojic ◽

...

Keyword(s):

Oxidative Stress ◽

Stress Response ◽

Smoking Status ◽

Abdominal Hysterectomy ◽

Oxidative Stress Response ◽

Oxidative Stress Markers ◽

Quality Of Recovery ◽

Stress Markers ◽

Duration Of Surgery

Abstract Study aimed to investigate relationship between oxidative stress markers and postoperative recovery in woman after abdominal hysterectomy, as well as to test the hypothesis that different analgesics differently influence redox status. The quality of recovery was evaluated with a QoR-40 questionnaire in fifty-one patients who underwent abdominal hysterectomy, preoperatively and on the 1st, 2nd, 3rd postoperative days (POD1,2,3). Blood samples were collected at baseline (T0), 3 (T1), 24 (T2), 48 (T3) and 72 (T4) hours after surgery. Oxidative stress markers concentrations (TBARS, NO2−, H2O2, O2− ) as well as antioxidative enzymes (SOD, CAT, and GSH) were analyzed. QoR-40 total score significantly declined on POD1 and POD2 and returned to baseline levels on POD3 (p<0.001). H2O2 levels significantly decreased from T0 to T3 and then, increased at T4 (p=0,011). Changes of TBARS and H2O2 from T0 to T3 showed significant and negative correlation (r=−0.303, p=0.046). There was no significant correlation between QoR-40 total score and any parameter of oxidative stress response (p>0.05). Changes in TBARS levels from T0 to T3 were statistically significant between the study subgroups primarily due to increase of the concentrations in patients receiving paracetamol (p=0.031). Patients age, duration of surgery and cigarette smoking status showed significant influcences on and association with some oxidative stress response markers (TBARS, O2−, CAT) (p<0.05). Women who underwent hysterectomy had significant changes of H2O2 and TBARS activity however, those changes were not associated with changes of QoR-40 total scores during recovery.

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Addition of dexmedetomidine or fentanyl to ropivacaine for transversus abdominis plane block: evaluation of effect on postoperative pain and quality of recovery in gynecological surgery

Journal of Pain Research ◽

10.2147/jpr.s178516 ◽

2018 ◽

Vol Volume 11 ◽

pp. 2897-2903 ◽

Cited By ~ 2

Author(s):

Qi Chen ◽

Xing Liu ◽

Xuejiao Zhong ◽

Bin Yang

Keyword(s):

Postoperative Pain ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Gynecological Surgery ◽

Transversus Abdominis Plane ◽

Quality Of Recovery

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Cost-efficacy of Rofecoxib versus Acetaminophen for Preventing Pain after Ambulatory Surgery

Anesthesiology ◽

10.1097/00000542-200210000-00027 ◽

2002 ◽

Vol 97 (4) ◽

pp. 931-937 ◽

Cited By ~ 42

Author(s):

Tijani Issioui ◽

Kevin W. Klein ◽

Paul F. White ◽

Mehernoor F. Watcha ◽

Gary D. Skrivanek ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Postoperative Pain ◽

Confidence Interval ◽

Analgesic Efficacy ◽

Additional Patient ◽

Controlled Study ◽

Quality Of Recovery ◽

Analgesic Medication

Background Nonsteroidal antiinflammatory drugs are commonly administered as part of a multimodal regimen for pain management in the ambulatory setting. This randomized, double-blinded, placebo-controlled study was designed to compare the analgesic effect of oral rofecoxib, a cyclooxygenase-2 inhibitor, and acetaminophen when administered alone or in combination prior to outpatient otolaryngologic surgery. Methods A total of 143 healthy outpatients undergoing elective otolaryngologic surgery were assigned to one of four study groups: group 1 = control (500 mg vitamin C); group 2 = 2 g acetaminophen; group 3 = 50 mg rofecoxib; or group 4 = 2 g acetaminophen and 50 mg rofecoxib. The first oral dose of the study medication was taken 15-45 min before surgery, and a second dose of the same medication was administered on the morning after surgery. Recovery times, side effects, and the need for rescue analgesics were recorded. Follow-up evaluations were performed at 24 and 48 h after surgery to assess postdischarge pain, analgesic requirements, nausea, and patient satisfaction with their postoperative pain management and quality of recovery. Peak pain scores and the need for rescue analgesic medication were used as the endpoints for estimating efficacy of the study drugs, while cost to achieve complete satisfaction with analgesia was used in the cost-effectiveness analysis. Results Premedication with rofecoxib (50 mg) was significantly more effective than either placebo or acetaminophen (2 g) in reducing the peak postoperative pain, the need for analgesic medication, and improving the quality of recovery and patient satisfaction. Moreover, the addition of acetaminophen failed to improve its analgesic efficacy. An expenditure for rofecoxib of 16.76 US dollars (95% confidence interval, 7.89 to 21.03 US dollars) and 30.24 US dollars (95% confidence interval, 5.25 to 54.20 US dollars) would obtain complete satisfaction with pain control in one additional patient who would not have been satisfied if placebo or acetaminophen, respectively, had been administered prior to surgery. Conclusions Rofecoxib, 50 mg administered orally, decreased postoperative pain and the need for analgesic rescue medication after otolaryngologic surgery. The addition of 2 g oral acetaminophen failed to improve its analgesic efficacy.

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Poor quality recovery after neoplastic surgery according to postoperative quality of recovery scale

10.26226/morressier.58f5b02fd462b80296c9e11b ◽

2017 ◽

Author(s):

Beatriz Carvalho

Keyword(s):

Poor Quality ◽

Quality Of Recovery ◽

Postoperative Quality

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Quality of recovery and acute postoperative pain

10.26226/morressier.58f5b02fd462b80296c9e2be ◽

2017 ◽

Author(s):

Ramiro Marinho

Keyword(s):

Postoperative Pain ◽

Acute Postoperative Pain ◽

Quality Of Recovery

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Combined Opioid Free and Loco-Regional Anesthesia Enhances the Quality of Recovery in Sleeve Gastrectomy Done Under ERAS Protocol: A Randomized Controlled Trial

10.21203/rs.3.rs-558975/v1 ◽

2021 ◽

Author(s):

Mohamed Ibrahim ◽

Ali M Elnabtity ◽

Ahmed Hegab ◽

Omar A. Alnujaidi ◽

Osama El Sanea

Keyword(s):

Postoperative Pain ◽

Regional Anesthesia ◽

Oral Fluid ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

P Value ◽

Rescue Analgesia ◽

Quality Of Recovery ◽

Eras Protocol

Abstract Background: There is still debate as to whether opioid-free anaesthsia (OFA) may offer additional benefit over multimodal analgesia to better achieve the goals of ERAS(Enhanced recovery after surgery) in bariatric surgery.Patients and method: Patients in the OFA group (n=51) were pre-medicated with IV dexmedetomidine 0.1 µg.kg-1 then induced with propofol (2 mg. kg-1) -ketamine (0.5 mg. kg-1) mixture and maintained on dexmedetomidine 0.5µg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1. Patients in the MMA(Multimodal analgesia) group (n= 52) were induced using IV propofol 2 mg. kg-1, and fentanyl 1 µg. kg-1. Cisatracurium (0.15 mg.kg-1) was given to all patients for muscle relaxation. Ultrasound-guided bilateral oblique subcostal transverse abdominis plane (OSTAP) block was performed in all patients. The postoperative quality of recovery at 6 and 24 hours was measured as a primary outcome. Postoperative pain control; subsequent opioid consumption; time to ambulate; time to tolerate oral fluid; and time to readiness for discharge were measured as secondary outcomes Results: The total QoR-40 (quality of recovery-40) scores at 6 hours were significantly higher in the OFA group (184.84 versus 180.69 in the MMA group with an estimated difference in mean of -4.15, 95% CI, -5.78 to -2.5, and P ˂0.001. The OFA group tolerated oral fluid intake earlier (194.94, 95% CI, 162.59 to 227.30) versus (273, 95% CI, 223.65 to 322.27) for the MMA group (p value=0.009). Readiness for discharge was significantly quicker in the OFA group (447.49, 95% CI, 409.69 to 485.29 versus 544.56, 95% CI, 503.08 to 586.04 in the MMA group, P-value =0.001). The post-anesthesia care unit (PACU) (0 Hour) and the floor 2 and 6-hour numerical rating scales (NRS) for pain were significantly higher in the MMA group. The OFA group needed less opioid rescue analgesia in the PACU and at 24-hours (P value= 0.003 and 0.014; respectively).Conclusion: Combined Opioid free and loco-regional anesthesia provides better early recovery with reduced postoperative pain intensity, and opioid consumption when compared to multimodal analgesia; and is better suited to achieve the goals of ERAS protocol.Clinical trial number: registration number NCT04285255.

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