Type of anesthesia and quality of recovery in male patients undergoing lumbar surgery: a randomized trial comparing propofol-remifentanil total i.v. anesthesia with sevoflurane anesthesia

Abstract Background Previous studies have shown that women achieve a better quality of postoperative recovery from total intravenous anesthesia (TIVA) than from inhalation anesthesia, but the effect of anesthesia type on recovery in male patients is unclear. This study therefore compared patient recovery between males undergoing lumbar surgery who received TIVA and those who received sevoflurane anesthesia. Methods Eighty male patients undergoing elective one- or two-level primary transforaminal lumbar interbody fusion (TLIF) were randomly divided into two groups: the TIVA group (maintenance was achieved with propofol and remifentanil) or sevoflurane group (SEVO group: maintenance was achieved with sevoflurane and remifentanil). The quality of recovery-40 questionnaire (QoR-40) was administered before surgery and on postoperative days 1 and 2 (POD1 and POD2). Pain scores, postoperative nausea and vomiting, postoperative hospital stay, anesthesia consumption, and adverse effects were recorded. Results The QoR-40 scores were similar on the three points (Preoperative, POD1 and POD2). Pain scores were significantly lower in the SEVO group than in the TIVA group on POD1 (30.6 vs 31.4; P = 0.01) and POD2 (32 vs 33; P = 0.002). There was no significant difference in the postoperative hospital stay or complications in the postanesthesia care unit between the TIVA group and the SEVO group. Conclusions This study demonstrates that the quality of recovery is not significantly different between male TLIF surgery patients who receive TIVA and those who receive sevoflurane anesthesia. Patients in the TIVA group had better postoperative analgesic effect on POD2. Trial registration This was registered at http://www.chictr.org.cn (registration number ChiCTR-IOR-16007987, registration date: 24/02/2016).

Download Full-text

The Quality of Recovery after Dexamethasone, Ondansetron, or Placebo Administration in Patients Undergoing Lower Limbs Orthopedic Surgery under Spinal Anesthesia Using Intrathecal Morphine. A Randomized Controlled Trial

Anesthesiology Research and Practice ◽

10.1155/2020/9265698 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Eduardo Toshiyuki Moro ◽

Miguel Antônio Teixeira Ferreira ◽

Renyer dos Santos Gonçalves ◽

Roberta Costa Vargas ◽

Samira Joverno Calil ◽

...

Keyword(s):

Spinal Anesthesia ◽

Orthopedic Surgery ◽

Intrathecal Morphine ◽

Controlled Trial ◽

Lower Limbs ◽

Postanesthesia Care Unit ◽

Quality Of Recovery ◽

Pain Scores ◽

To Receive

Intrathecal morphine is widely and successfully used to prevent postoperative pain after orthopedic surgery, but it is frequently associated with side effects. The aim of this study was to evaluate the effect of dexamethasone or ondansetron when compared to placebo to reduce the occurrence of these undesirable effects and, consequently, to improve the quality of recovery based on patient’s perspective. Methods. One hundred and thirty-five patients undergoing lower extremity orthopedic surgery under spinal anesthesia using bupivacaine and morphine were randomly assigned to receive IV dexamethasone, ondansetron, or saline. On the morning following surgery, a quality of recovery questionnaire (QoR-40) was completed. Results. No differences were detected in the global and dimensional QoR-40 scores following surgery; however, following postanesthesia care unit (PACU) discharge, pain scores were higher in patients receiving ondansetron compared with patients who received dexamethasone. Conclusion. Neither ondansetron nor dexamethasone improves the quality of recovery after lower limbs orthopedic surgery under spinal anesthesia using intrathecal morphine.

Download Full-text

Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

Anesthesiology ◽

10.1097/aln.0b013e3181ec642e ◽

2011 ◽

Vol 114 (4) ◽

pp. 882-890 ◽

Cited By ~ 98

Author(s):

Glenn S. Murphy ◽

Joseph W. Szokol ◽

Steven B. Greenberg ◽

Michael J. Avram ◽

Jeffery S. Vender ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Postanesthesia Care Unit ◽

Control Group ◽

Quality Of Recovery ◽

Pain Scores ◽

Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P < 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P < 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P < 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

Download Full-text

Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty

The American Surgeon ◽

10.1177/0003134821989051 ◽

2021 ◽

pp. 000313482198905

Author(s):

John A. Perrone ◽

Stephanie Yee ◽

Manrique Guerrero ◽

Antai Wang ◽

Brian Hanley ◽

...

Keyword(s):

Quality Of Life ◽

Statistical Analysis ◽

Hospital Stay ◽

Hiatal Hernia ◽

Collis Gastroplasty ◽

Significant Difference ◽

Related Quality

Introduction After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. Methods This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. Results Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups ( P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions ( P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) ( P = .01). The LOH stay was not significantly different ( P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. Conclusion Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

Download Full-text

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Download Full-text

Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine1734 ◽

2018 ◽

Vol 28 (1) ◽

pp. 119-126 ◽

Cited By ~ 42

Author(s):

Lauren K. Dunn ◽

Marcel E. Durieux ◽

Lucas G. Fernández ◽

Siny Tsang ◽

Emily E. Smith-Straesser ◽

...

Keyword(s):

Spine Surgery ◽

Rating Scale ◽

Psychological Intervention ◽

Opioid Consumption ◽

Anxiety And Depression ◽

Opioid Use ◽

Quality Of Recovery ◽

Pain Scores ◽

The Impact

OBJECTIVEPerception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODSPatients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTSOne hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).CONCLUSIONSCatastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

Download Full-text

Bilateral cervical plexus block for anterior cervical spine surgery: study protocol for a randomised placebo-controlled trial

Trials ◽

10.1186/s13063-021-05377-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Michael J. Mulcahy ◽

Thananchayan Elalingam ◽

Kevin Jang ◽

Mario D’Souza ◽

Matthew Tait

Keyword(s):

Cervical Spine ◽

Hospital Stay ◽

Controlled Trial ◽

Cervical Plexus ◽

Cervical Spine Surgery ◽

Quality Of Recovery ◽

Anterior Cervical Spine Surgery ◽

Cervical Plexus Block ◽

Plexus Block

Abstract Background There has been increasing focus to improve the quality of recovery following anterior cervical spine surgery (ACSS). Postoperative pain and nausea are the most common reasons for prolonged hospital stay and readmission after ACSS. Superficial cervical plexus block (SCPB) provides site-specific analgesia with minimal side effects, thereby improving the quality of recovery. The aim of our study was to investigate the effect bilateral cervical plexus block has on postoperative recovery in patients undergoing ACSS. Methods The study is a pragmatic, multi-centre, blinded, parallel-group, randomised placebo-controlled trial. 136 eligible patients (68 in each group) undergoing ACSS will be included. Patients randomised to the intervention group will have a SCPB administered under ultrasound guidance with a local anaesthetic solution (0.2% ropivacaine, 15mL); patients randomised to the placebo group will be injected in an identical manner with a saline solution. The primary outcome is the 40-item quality of recovery questionnaire score at 24 h after surgery. In addition, comparisons between groups will be made for a 24-h opioid usage and length of hospital stay. Neck pain intensity will be quantified using the numeric rating scale at 1, 3, 6 and at 24 h postoperatively. Incidence of nausea, vomiting, dysphagia or hoarseness in the first 24 h after surgery will also be measured. Discussion By conducting a blinded placebo trial, we aim to control for the bias inherently associated with a tangible medical intervention and show the true treatment effect of SCPB in ACSS. A statistically significant result will indicate an overall improved quality of recovery for patients; alternatively, if no benefit is shown, this trial will provide evidence that this intervention is unnecessary. Trial registration ClinicalTrials.gov ACTRN12619000028101. Prospectively registered on 11 January 2019 with Australia New Zealand Clinical Trials Registry

Download Full-text

The Severity of Fatigue Among Bone Marrow Transplantation Patients

Journal of Global Oncology ◽

10.1200/jgo.18.10200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 99s-99s

Author(s):

O. Abdalrahman ◽

E. Almashaikh ◽

H. Aljarrah

Keyword(s):

Quality Of Life ◽

Bone Marrow ◽

Bone Marrow Transplantation ◽

Cancer Patients ◽

Subscale Score ◽

Medical Intervention ◽

Significant Difference ◽

Fatigue Severity ◽

Male Patients

Background: Fatigue interferes with the individual´s functioning and quality of life in cancer patients specifically, after chemotherapy and post–bone marrow transplantation (BMT), fatigue is not adequately addressed and prioritized among health care providers. Aim: The purpose of this study is to determine the severity and prevalence of fatigue among cancer patients post-BMT after receiving chemotherapy. Methods: A descriptive, cross-sectional and correlational design was used, Piper fatigue scale (PFS) Arabic version was used to measure participants' level of fatigue, the scale measures four dimensions of subjective fatigue: behavioral, affective, sensory, and cognitive. Patients above 18 years old, received chemotherapy and do BMT between Oct 2016 and Oct 2017, were included in this study. Results: 100 patient participated in this study, 52% (N: 52) diagnosed with leukemia, 32% (N: 32) lymphoma, and 16% (N: 16) hematology. Thirty-nine patients (39%) had no or mild fatigue level, they do not need medical intervention, 47% (N: 47) and 14% (N: 14) classified as moderate and sever level of fatigue respectively, equal to 61% of the total sample who need medical intervention. Overall fatigue severity categories; mild, moderate, and sever shows that there is significant difference in term of severity subscale in sensory and behavioral dimensions ( P = 0.03, 0.004) respectively, and the other subscale dimension did not significantly differ among patient ( P > 0.05), the highest mean subscale score occurred in the behavioral dimension (M = 4.8, SD = 2.37), while the lowest mean subscale score occurred in cognitive dimension, (M=2.59, SD=2.35). The overall score mean of the male patients regarding the fatigue severity was 45.18 (n=74), and for the female patients the mean was 57.03 (n=26), and the result shows that there was significant difference in the overall mean scores between male patients and female patients (t (98)= −2.2, P < 0.05). Conclusion: Fatigue-related to BMT is a serious and prevalent problem among patients with cancer. Fatigue may impair quality of life among this group of patients; further study may be conducted to assess the effect of fatigue on quality of life and activity of daily living. It is essential to include fatigue assessment as a priority for the BMT patients.

Download Full-text

Gender and Quality of Life After Cerebral Stroke

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2010.2701 ◽

2010 ◽

Vol 10 (2) ◽

pp. 94-99 ◽

Cited By ~ 12

Author(s):

Amra Zalihić ◽

Vedran Markotić ◽

Dino Zalihić ◽

Mirela Mabić

Keyword(s):

Quality Of Life ◽

Life Quality ◽

Female Gender ◽

Cerebral Stroke ◽

Female Patients ◽

Negative Prognostic Factor ◽

Significant Difference ◽

Medium Range ◽

Male Patients

The aim of this work is to investigate the influence of gender on recovery after cerebral stroke.It is believed that functional outcome of cerebral stroke (CS) depends on gender. Female gender is mildly negative prognostic factor in after stroke results. Two hundred and two patients who had first ischemic cerebral stroke were questioned with help of, HADS and WHOQOL-Bref questionnaires, looking for differences in recovery depending on gender. Average patients' age was 72+/-13 (ME+/-IR) years. The youngest patient had 40 years, and the oldest 92 years, and medium range was 52 years. There were 112 males and 90 females. Quality of life was equally graded by both male and female after CS (p=0.208). Male patients had significantly better results in physical (p=0.035) and psychological (p=0.020) domain of life quality. After CS, male patients had better results only in memory dimension (p=0.003). Anxiety was statistically more frequent among female patients (p=0.009). Gender did not influence frequency of metabolic syndrome in patients with CS. Quality of life after CS was better in male patients, and statistically significant difference has been shown in physical, psychological domain and memory dimension. Female patients were more anxious then male after CS.

Download Full-text

Subanalysis of the StiL NHL 1–2003 Study: Achievement of Complete Response with Bendamustine-Rituximab (B-R) and CHOP-R in the First-Line Treatment of Indolent and Mantle Cell Lymphomas Results in Superior Survival Compared to Partial Response.

Blood ◽

10.1182/blood.v120.21.2724.2724 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2724-2724 ◽

Cited By ~ 1

Author(s):

Mathias J. Rummel ◽

Norbert Niederle ◽

Georg Maschmeyer ◽

G.-Andre Banat ◽

Ulrich von Grünhagen ◽

...

Keyword(s):

Complete Response ◽

Line Treatment ◽

First Line ◽

Female Patients ◽

Significant Difference ◽

Mantle Cell ◽

Male Patients ◽

The Impact ◽

First Line Treatment

Abstract Abstract 2724 Background: The NHL 1 study, a prospective, multicenter, randomized, phase 3 study which compared B-R and CHOP-R as first-line treatment in indolent lymphomas and mantle cell lymphoma (MCL), demonstrated a significant benefit in progression-free survival (PFS) as well as improved tolerability for B-R compared with CHOP-R. Here we present an analysis of the impact of response quality on outcome. Methods: 514 patients (pts) with indolent or MCL were randomized to receive B-R or CHOP-R for a maximum of 6 cycles. Results: The overall response rate in the 514 pts (261 B-R; 253 CHOP-R) was 92.7% and 91.3% in the B-R and CHOP-R arms, respectively (as presented at the last ASCO meeting, J Clin Oncol 30, 2012 (suppl; abstr 3). A complete response (CR) was observed in 39.8% in the B-R arm and in 30% in the CHOP-R arm (p=0.021). The achievement of CR was associated with a significantly prolonged PFS and overall survival (OS) (Table 1). Analysis by treatment arm revealed a trend for superior PFS and a significantly improved OS for patients achieving CR following treatment with B-R. In the CHOP-R arm, patients in CR had a significantly superior PFS compared to those in PR with a trend to superior OS. Regardless of the quality of response, PFS was superior with B-R versus CHOP-R: For patients in CR, the median PFS was not reached with B-R, whereas for CHOP-R it was 53.7 months (p=0.0204). In patients achieving PR, treatment with B-R resulted in a median PFS of 57.2 months, and this was 30.9 months with CHOP-R (p=0.0002). We noted a statistically significant difference in CR rates between male (n=272, median age 63 years) and female (n=242, median age 64 years) patients. The CR rate was 28.6% in male patients and 42.1% in female patients (p=0.0016). Female patients had a longer median PFS (51.4 months) compared to male patients (38.6 months), however, this difference was not statistically significant (p=0.0866). Conclusions: Patients in CR following first-line treatment in our study had a significantly longer PFS and OS compared to those achieving a PR. Therefore, our results strongly suggest an association between quality of response and outcome. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Comparison of the Effect of Passive and Active Recovery, and Self-Myofascial Release Exercises on Lactate Removal and Total Quality of Recovery

Journal of Education and Training Studies ◽

10.11114/jets.v6i9a.3511 ◽

2018 ◽

Vol 6 (9a) ◽

pp. 33 ◽

Cited By ~ 2

Author(s):

İlbilge Özsu ◽

Baris Gurol ◽

Cem Kurt

Keyword(s):

Strenuous Exercise ◽

Total Quality ◽

Active Recovery ◽

Wingate Anaerobic Test ◽

Subsequent Performance ◽

Myofascial Release ◽

Quality Of Recovery ◽

Significant Difference ◽

Exercise Induced

Recovery from exercise-induced fatigue is crucial for subsequent performance. Self-myofascial release (SMR) using a foam roller is an alternative to active recovery (AR). This study aims to compare the effects of passive recovery (PR), AR, and SMR on blood lactate [La-] removal and total quality of recovery (TQR). Twenty-two well trained male athletes (age: 22.6±2.9 years) underwent three testing sessions conducted 72 hours apart but at the same time of each day in a randomized order. After determining resting [La-] and heart rate (HR), the subjects completed a Wingate anaerobic test (WAnT), triggering muscular fatigue. HR and [La-] were measured threeminutes after the WAnT, following which the subjects underwent one of the three different recovery interventions over 15 minutes: PR (lying supine), AR (cycling at 40% of the estimated maximum HR of the respective subject), and SMR (using foam roller on lower extremity muscles). After each recovery intervention, [La-], HR, and TQR were measured. There was no statistically significant difference in [La-] and HR values obtained before the WAnT test (p=0.368, p=0.691, respectively) and right after the WAnT test (0.264, p=0.629) Both AR and SMR were more effective than PR for [La-] removal and obtaining a higher TQR (p<0.001). However, SMR and AR were not superior to one another for blood [La-] removal (p>0.05). In contrast, a significantly higher TQR was observed with SMR than AR and PR (p<0.001). Athletes can apply AR or SMR to recover from strenuous exercise. SMR can be an alternative to PR and AR as a recovery tool.

Download Full-text