title: Fast-track hysterectomy: a randomised, controlled study.
abstract: OBJECTIVE
  To investigate if intrathecally administered morphine combined with a low-dose mode of total intravenous anaesthesia (TIVA) accelerates recovery after abdominal surgery as compared, to patient-controlled analgesia (PCA) combined with anaesthesia, based on volatile anaesthetics.
  
  
  METHODS
  Fifty-three patients who were hysterectomised abdominally were randomised to TIVA or PCA. Their per- and post-operative course was strictly monitored and their pain score was evaluated with a visual analogue scale at repeated time intervals.
  
  
  RESULTS
  Patients with TIVA had a significantly shorter stay on the post-operative ward, 180 (105-330)min, compared with the PCA group, 237 (120-1140)min (p<0.01). The start of peroral fluid also differed significantly between groups, 4h (2-6) for TIVA versus 5h (2-24) for the PCA group (p<0.01). The removal of the indwelling catheter took place significantly earlier in the TIVA group, 9h (5-23) versus 22h (17-24) in the PCA group (p<0.0001). There was significantly less post-operative nausea in the TIVA group compared with the PCA group on the first post-operative day (p<0.01). The length of stay was shorter, 2 days (1-3) compared with 3 days (1-6) for the TIVA group versus PCA (p<0.001). There was no difference in complications between groups. One patient in each group was re-admitted to hospital because of a vaginal cuff infection.
  
  
  CONCLUSIONS
  The TIVA per- and post-operative care was an advantage over PCA in most respects.
authors.affiliation: Department of Obstetrics and Gynaecology, Norra Alvsborg County Hospital, 461 85 Trollhättan, Sweden. ulla-beth.kroon@vgregion.se
authors.forename: Ulla-Beth
authors.initials: UB
authors.lastname: Kroon
authors.forename: Michael
authors.initials: M
authors.lastname: Rådström
authors.forename: Carin
authors.initials: C
authors.lastname: Hjelthe
authors.forename: Christer
authors.initials: C
authors.lastname: Dahlin
authors.forename: Lars
authors.initials: L
authors.lastname: Kroon
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000777:Anesthetics; D009020:Morphine