The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial.
OBJECTIVE
to determine whether the duration of hospital stay after abdominal hysterectomy in a fast-track setting differed between women operated under general anaesthesia or in spinal anaesthesia with intrathecal morphine.


METHODS
an open randomised controlled multicentre study.


METHODS
five hospitals in the south-east of Sweden.


METHODS
one hundred and eighty women scheduled for benign hysterectomy were randomised: 162 completed the study, 82 were allocated to spinal anaesthesia and 80 were allocated to general anaesthesia.


METHODS
fast-track model comprising no use of sedatives for premedication, pre-emptive anti-emetic therapy, intravenous fluid restriction, analgesics based on non-opioids, early enteral nutrition and mobilisation, and standard criteria for discharge. Spinal anaesthesia with 20 mg hyperbaric bupivacaine and 0.2 mg morphine. General anaesthesia with propofol, fentanyl and rocuronium, and with continuous propofol and ventilation with oxygen-in-air for maintenance of anaesthesia.


METHODS
hospital stay, consumption of analgesics, vomiting, pruritus and bowel function recovery.


RESULTS
median hospitalisation did not differ significantly between women who had hysterectomy with spinal or general anaesthesia (46 and 50 hours, respectively). Spinal anaesthesia was associated with a significantly lower use of opioids and a faster recovery of bowel function, although vomiting and pruritus were more prevalent.


CONCLUSIONS
in a fast-track model the duration of hospitalisation after abdominal hysterectomy was < 50 hours, independent of the mode of anaesthesia. Spinal anaesthesia reduced the need for postoperative morphine compared with general anaesthesia. In order to improve patient recovery after gynaecological surgery further studies based on fast-track programmes are needed.
Borendal Wodlin
N
N
Division of Women and Child Health, Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping, Sweden. Ninnie.Borendal.Wodlin@lio.se
Nilsson
L
L
Kjølhede
P
P
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007278:Injections, Spinal; D007902:Length of Stay; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011292:Premedication; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology
D000701:Analgesics, Opioid; D009020:Morphine