Fast-track hysterectomy: a randomised, controlled study.
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.
Kroon
Ulla-Beth
UB
Department of Obstetrics and Gynaecology, Norra Alvsborg County Hospital, 461 85 Trollhättan, Sweden. ulla-beth.kroon@vgregion.se
Rådström
Michael
M
Hjelthe
Carin
C
Dahlin
Christer
C
Kroon
Lars
L
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
D000777:Anesthetics; D009020:Morphine