TIVA does not offer better quality recovery than sevoflurane maintenance in ambulatory gynecological surgery.

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• Gildasio S De Oliveira, Jane Bialek, Meghan E Rodes, Mark C Kendall, and Robert J McCarthy.
• Department of Anesthesiology, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Surgery, Alpert School of Medicine, Brown University, United States; Department of Health Services Research, Practice and Policy, The School of Public health, Brown University, United States. Electronic address: Gildasio.oliveira@lifespan.org.
• J Clin Anesth. 2017 Dec 1; 43: 70-74.

ObjectiveThe main objective of the current investigation was to evaluate the effect of propofol used as anesthetic maintenance compared to sevoflurane on global post-surgical quality of recovery in female patients undergoing ambulatory gynecological surgery.DesignThe study was a prospective randomized double blinded, controlled, clinical trial.InterventionsHealthy female subjects were randomized to receive propofol or sevoflurane as anesthetic maintenance.MeasurementsThe primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24h after surgery. Other data collected included opioid consumption, pain scores and time to hospital discharge. P<0.05 was used to reject the null hypothesis for the primary outcome.Main ResultsNinety subjects were randomized and sixty seven completed the study. Patient's baseline characteristics and surgical factors were not different between study groups. There was not a clinically significant difference in the global QoR-40 scores between the sevoflurane and the propofol groups, median (IQR) of 175 (163 to 181) and 176 (163 to 184), respectively, P=0.97. There was an inverse relationship (ρ=-0.42) between the opioid consumption in PACU (IV morphine equivalents) and 24h postoperative quality of recovery (P<0.001) and an inverse relationship (ρ=-0.48) between the oral opioid consumption at home (oral morphine equivalents) and 24h postoperative quality of recovery, P<0.001.ConclusionsOur current results do not support the use of total intravenous anesthesia as an efficacious strategy to improve global quality of recovery after ambulatory surgery. Opioid consumption in the PACU is an earlier surrogate that can be utilized to identify ambulatory patients with a high likelihood to develop poor global quality of recovery and who may benefit from more efficacious strategies to improve global quality of recovery.Trial RegistrationClinicalTrial.gov; url: http://www.clinicaltrials.gov; registration identified: NCT 01755234.Copyright © 2017 Elsevier Inc. All rights reserved.

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