Inhalational versus intravenous maintenance of anesthesia for quality of recovery in patients undergoing corrective lower limb osteotomy: A randomized controlled trial

Seung Hyun Kim, Hyang Mi Ju, Chong-Hyuck Choi, Hae Ri Park, Seokyung Shin, Seung Hyun Kim, Hyang Mi Ju, Chong-Hyuck Choi, Hae Ri Park, Seokyung Shin

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT flowchart of patient sample…
Fig 1. CONSORT flowchart of patient sample selection.
Fig 2
Fig 2
Perioperative (A) heart rate (beates/min) and (B) mean blood pressure (mmHg) of the Desflurane and TIVA group at six perioperative time-points; 1: at baseline before induction, 2: 10 min after anesthesia induction, 3: at cessation of anesthetics, 4: at tracheal extubation, 5: admission to post anesthesia care unit (PACU), 6: discharge from PACU. *P

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