[Do short-term duration drugs for anaesthesia give postoperative advantages compared to traditional drugs?].
BACKGROUND
We wanted to compare totally intravenous anaesthesia with propofol and remifentanil to mixed anaesthesia with isoflurane and fentanyl in terms of postoperative pain, nausea, length of stay and costs.


METHODS
We present a prospective, non-randomised, anaesthetist-based double-blind study with a cost-utility analysis on consecutive patients undergoing laparoscopic gynaecologic day-care surgery. Premedication consisted of paracetamol and diclofenac. The mixed anaesthesia group received propofol, isoflurane, fentanyl, vecuronium, N2O and O2,the total intravenous group propofol, remifentanil, vecuronium, N2O and O2. Paracetamol and ketobemidon, metoklopramid and ondansetron were given to relieve pain and nausea, respectively. Patients were asked to report pain and nausea on a visual analogue scale after 4 and 24 hours.


RESULTS
26 mixed and 27 totally intravenous patients were comparable by age, body mass index and ASA (American Society of Anesthesiologists) scores. There was a protocol violation, as fewer totally intravenous patients received pre-medication (16/26 vs. 8/27 p < 0.001). Totally intravenous patients had significantly higher consumption of ketobemidon (mean 2.35 vs. 5.43 mg/24 h p < 0.004). Within the totally intravenous group, scores for pain at 24 hours were significantly higher as compared with 4-hour scores (p = 0.012). At 24 hours, scores for nausea were significantly higher for the totally intravenous group (1.87 vs. 3.21 p = 0.014). Length of stay did not differ significantly (mean 649 vs. 729 min p > 0.2). Costs of medication were significantly higher for the totally intravenous group (mean 211 vs 285 NOK p <0.001).


CONCLUSIONS
The use of totally intravenous anaesthesia led to more nausea and more expenses than mixed anaesthesia in laparoscopic gynaecologic day-care surgery. No recommendations for either method can be made because of the non-randomized design.
Laberg
Geir Ole
GO
Anestesiavdelingen, Førde Sentralsjukehus.
Leirvåg
Jan Petter
JP
Leeuwenberg
Joost
J
Bergamaschi
Roberto
R
D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics; D009609:Nitrous Oxide / Q000008:administration & dosage; D010149:Postoperative Pain / Q000175:diagnosis; D010880:Piperidines / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D014673:Vecuronium Bromide / Q000008:administration & dosage
D018686:Anesthetics, Intravenous; D010880:Piperidines; D014673:Vecuronium Bromide; D007530:Isoflurane; D009609:Nitrous Oxide; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol