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The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
2011 (English)In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 118, no 3, 299-308 p.Article in journal (Refereed) Published
Abstract [en]

Objective To determine whether the duration of hospital stay after abdominal hysterectomy in a fast-track setting differed between women operated under general anaesthesia or in spinal anaesthesia with intrathecal morphine. Design An open randomised controlled multicentre study. Setting Five hospitals in the south-east of Sweden. Population One hundred and eighty women scheduled for benign hysterectomy were randomised: 162 completed the study, 82 were allocated to spinal anaesthesia and 80 were allocated to general anaesthesia. Methods Fast-track model comprising no use of sedatives for premedication, pre-emptive anti-emetic therapy, intravenous fluid restriction, analgesics based on non-opioids, early enteral nutrition and mobilisation, and standard criteria for discharge. Spinal anaesthesia with 20 mg hyperbaric bupivacaine and 0.2 mg morphine. General anaesthesia with propofol, fentanyl and rocuronium, and with continuous propofol and ventilation with oxygen-in-air for maintenance of anaesthesia. Main outcome measures Hospital stay, consumption of analgesics, vomiting, pruritus and bowel function recovery. Results Median hospitalisation did not differ significantly between women who had hysterectomy with spinal or general anaesthesia (46 and 50 hours, respectively). Spinal anaesthesia was associated with a significantly lower use of opioids and a faster recovery of bowel function, although vomiting and pruritus were more prevalent. Conclusions In a fast-track model the duration of hospitalisation after abdominal hysterectomy was andlt; 50 hours, independent of the mode of anaesthesia. Spinal anaesthesia reduced the need for postoperative morphine compared with general anaesthesia. In order to improve patient recovery after gynaecological surgery further studies based on fast-track programmes are needed.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd. , 2011. Vol. 118, no 3, 299-308 p.
Keyword [en]
Fast-track, general anaesthesia, hysterectomy, intrathecal morphine, randomised study, spinal anaesthesia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-66315DOI: 10.1111/j.1471-0528.2010.02697.xISI: 000286148300006OAI: oai:DiVA.org:liu-66315DiVA: diva2:403221
Note

This is the authors’ version of the following article: Ninnie Borendal Wodlin, Lena Nilsson and Preben Kjölhede, The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial, 2011, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, (118), 3, 299-308. which has been published in final form at: http://dx.doi.org/10.1111/j.1471-0528.2010.02697.x Copyright: Blackwell Publishing Ltd. http://eu.wiley.com/WileyCDA/Brand/id-35.html

Available from: 2011-03-11 Created: 2011-03-11 Last updated: 2015-06-08
In thesis
1. Fast track abdominal hysterectomy: On the mode of anesthesia, postoperative recovery and health economics
Open this publication in new window or tab >>Fast track abdominal hysterectomy: On the mode of anesthesia, postoperative recovery and health economics
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Hysterectomy is the most common major gynecological operation in the Western World and approximately 5000 benign hysterectomies are performed in Sweden every year. Consequently it is a surgical procedure that affects many women. The procedure comprises challenges concerning perioperative health care, perceived postoperative symptoms, quality of life aspects and health economics. The concept of fast track is a multimodal strategy to reduce hormonal surgical stress response and achieve an enhanced postoperative recovery and is today considered to be evidence based in relation to colorectal surgery. Spinal anesthesia, as an important part of fast track, provides benefits of extended effect on analgesia and reduced postoperative morbidity. It is reasonable to believe that employing the strategies of fast track including spinal anesthesia could also provide substantial benefits for women requiring surgical removal of the uterus.

Aims: To determine whether duration of hospital stay, presence and intensity of postoperative symptoms, duration of sick leave and cost-effectiveness differ between women undergoing benign fast track abdominal hysterectomy in spinal anesthesia with intrathecal morphine (SA) and in standard general anesthesia (GA).

Material & Methods: 180 women participated in this open randomized multicenter study with five participating hospitals in the southeast region of Sweden. One hundred and sixty two completed the study; 82 women were randomized to SA and 80 to GA. A fast track model comprising premedication without sedatives, intravenous fluid regulation, analgesics based on non-opioids, pre-emptive antiemetic therapy, early enteral nutrition and mobilization and standard criteria for discharge were used. End points were duration of hospital stay, use of analgesics, perceived postoperative symptoms, occurrence of postoperative complications, duration of sick leave and health economic evaluations.

Results: Duration of hospital stay did not differ between the two modes of anesthesia. Vomiting and pruritus occurred significantly more often after SA. Complication rates did not differ between groups. Women with SA experienced less overall discomfort and had a reduced need for opioids postoperatively. Abdominal pain, drowsiness and fatigue occurred less often and with lower intensity among the women in the SA group. Health related quality of life improved faster and the duration of sick leave was shorter in women after SA. Total costs (hospital costs plus costs for productivity loss) were lower for the SA group. Within the first 29 days after hysterectomy the women in the SA group gained more QALYs than women in the GA group.

Conclusions: The duration of hospitalisation after fast track abdominal hysterectomy was less than 50 hours and mode of anesthesia did not influence this. SA displayed considerable advantages regarding postoperative symptoms and recovery. SA was considered cost-effective in comparison with GA due to lower total costs and more QALYs gained. Our study indicates that SA should be recommended as the first choice of anesthesia in benign abdominal hysterectomy.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1251
Keyword
Abdominal hysterectomy; Cost-effectiveness; Fast track; General anesthesia; Health economy; Intrathecal morphine; Postoperative recovery Postoperative symptoms Randomized study; Spinal anesthesia; Quality of Life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70469 (URN)978-91-7393-107-6 (ISBN)
Public defence
2011-10-07, Berzeliussalen, Ingång 65, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
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Supervisors
Available from: 2011-09-09 Created: 2011-09-09 Last updated: 2011-09-12Bibliographically approved

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Borendal Wodlin, NinnieNilsson, LenaKjölhede, Preben
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Obstetrics and gynecologyFaculty of Health SciencesAnesthesiologyDepartment of Anaesthesiology and Intensive Care in LinköpingDepartment of Gynaecology and Obstetrics in Linköping
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