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.

Study design: 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.

Conclusion: The TIVA per- and post-operative care was an advantage over PCA in most respects.