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Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial
BACKGROUND: We aimed to explore the impact of opioid-sparing anesthesia on patients’ quality of recovery after video-assisted thoracoscopic surgery (VATS). We tested the primary hypothesis that our predefined opioid-sparing anesthesia provides better quality of patients’ recovery compared to routine...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344409/ https://www.ncbi.nlm.nih.gov/pubmed/35928625 http://dx.doi.org/10.21037/jtd-22-50 |
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author | Qiu, Yuwei Lu, Xiaofei Liu, Yuan Chen, Xu Wu, Jingxiang |
author_facet | Qiu, Yuwei Lu, Xiaofei Liu, Yuan Chen, Xu Wu, Jingxiang |
author_sort | Qiu, Yuwei |
collection | PubMed |
description | BACKGROUND: We aimed to explore the impact of opioid-sparing anesthesia on patients’ quality of recovery after video-assisted thoracoscopic surgery (VATS). We tested the primary hypothesis that our predefined opioid-sparing anesthesia provides better quality of patients’ recovery compared to routine anesthesia in VATS. METHODS: Patients between 18 and 70 years, scheduled for elective VATS, had an American Society of Anesthesiologists (ASA) class I–III under general anesthesia, were randomly allocated to: routine anesthesia group and opioid-sparing anesthesia group. Patients in the opioid-sparing anesthesia group were mainly given preoperative thoracic paravertebral blockade with intraoperative withholding longer acting opioids. Patients in routine anesthesia group received opioid-based anesthesia. The primary outcome was the Quality of Recovery-15 scale (QoR-15) at 6 hours after surgery. The secondary outcomes included QoR-15 at 24 and 48 hours after surgery, Overall Benefit of Analgesia Score Satisfaction with pain treatment (OBAS) and acute pain intensity at 6, 24 and 48 hours after surgery, and clinical outcomes of recovery after surgery. RESULTS: A total of 159 patients were included in final analysis. The median difference in QoR-15 between opioid-sparing anesthesia and routine anesthesia was 4 (95% CI: 1–6) at 6 hours, 8 (95% CI: 4–12) at 24 hours and 4.7 (95% CI: 1–6) at 48 hours after surgery respectively; 73.4% of patient showed good recovery in opioid-sparing anesthesia group, compared to 53.8% in routine anesthesia group at 24 hours after surgery (P=0.01). Patients demonstrated lower OBAS in opioid-sparing anesthesia group compared to routine anesthesia at all time points after surgery (P<0.05). The pain at most was significantly lower in opioid-sparing anesthesia group compared to routine anesthesia at 6 and 48 hours after surgery (P<0.05). Patients exhibited faster recovery with opioid-sparing anesthesia on time to mobilize and time to first flatus (P<0.01). CONCLUSIONS: Our intraoperative opioid-sparing anesthesia cannot improve patients’ recovery at 6 hours after VATS lung surgery, but it demonstrates better outcomes at 24 hours after surgery compared to routine anesthesia, reaching to a clinically important difference. TRIAL REGISTRATION: This study is registered in the Chinese Clinical Trial Registry, ChiCTR2000031609. |
format | Online Article Text |
id | pubmed-9344409 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-93444092022-08-03 Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial Qiu, Yuwei Lu, Xiaofei Liu, Yuan Chen, Xu Wu, Jingxiang J Thorac Dis Original Article BACKGROUND: We aimed to explore the impact of opioid-sparing anesthesia on patients’ quality of recovery after video-assisted thoracoscopic surgery (VATS). We tested the primary hypothesis that our predefined opioid-sparing anesthesia provides better quality of patients’ recovery compared to routine anesthesia in VATS. METHODS: Patients between 18 and 70 years, scheduled for elective VATS, had an American Society of Anesthesiologists (ASA) class I–III under general anesthesia, were randomly allocated to: routine anesthesia group and opioid-sparing anesthesia group. Patients in the opioid-sparing anesthesia group were mainly given preoperative thoracic paravertebral blockade with intraoperative withholding longer acting opioids. Patients in routine anesthesia group received opioid-based anesthesia. The primary outcome was the Quality of Recovery-15 scale (QoR-15) at 6 hours after surgery. The secondary outcomes included QoR-15 at 24 and 48 hours after surgery, Overall Benefit of Analgesia Score Satisfaction with pain treatment (OBAS) and acute pain intensity at 6, 24 and 48 hours after surgery, and clinical outcomes of recovery after surgery. RESULTS: A total of 159 patients were included in final analysis. The median difference in QoR-15 between opioid-sparing anesthesia and routine anesthesia was 4 (95% CI: 1–6) at 6 hours, 8 (95% CI: 4–12) at 24 hours and 4.7 (95% CI: 1–6) at 48 hours after surgery respectively; 73.4% of patient showed good recovery in opioid-sparing anesthesia group, compared to 53.8% in routine anesthesia group at 24 hours after surgery (P=0.01). Patients demonstrated lower OBAS in opioid-sparing anesthesia group compared to routine anesthesia at all time points after surgery (P<0.05). The pain at most was significantly lower in opioid-sparing anesthesia group compared to routine anesthesia at 6 and 48 hours after surgery (P<0.05). Patients exhibited faster recovery with opioid-sparing anesthesia on time to mobilize and time to first flatus (P<0.01). CONCLUSIONS: Our intraoperative opioid-sparing anesthesia cannot improve patients’ recovery at 6 hours after VATS lung surgery, but it demonstrates better outcomes at 24 hours after surgery compared to routine anesthesia, reaching to a clinically important difference. TRIAL REGISTRATION: This study is registered in the Chinese Clinical Trial Registry, ChiCTR2000031609. AME Publishing Company 2022-07 /pmc/articles/PMC9344409/ /pubmed/35928625 http://dx.doi.org/10.21037/jtd-22-50 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Qiu, Yuwei Lu, Xiaofei Liu, Yuan Chen, Xu Wu, Jingxiang Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title | Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title_full | Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title_fullStr | Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title_full_unstemmed | Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title_short | Efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
title_sort | efficacy of the intraoperative opioid-sparing anesthesia on quality of patients’ recovery in video-assisted thoracoscopic surgery: a randomized trial |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344409/ https://www.ncbi.nlm.nih.gov/pubmed/35928625 http://dx.doi.org/10.21037/jtd-22-50 |
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