Quality of life at three years after cardiac surgery: relationship with preoperative status and quality of recovery

A reduction in symptoms, increased longevity, and improved quality of life (QoL), are goals of cardiac surgery. We measured QoL in 108 adult cardiac surgical patients at about three years after cardiac surgery, and assessed the predictive ability of a 40-item quality of recovery (QoR-40) score. Our follow-up rate was 86% (n = 93). When compared with preoperative status, QoL was improved at three years after surgery (P < 0.0005). The dimensions of QoL that were most affected were physical functioning, role limitations due to physical problems, vitality, social functioning, and role limitations due to emotional problems (all P < 0.005). There was a mild correlation between the day 3 QoR-40 and the three year SF-36, r = 0.23 (P = 0.029). There was a strong correlation between the three year QoR-40 and the three year SF-36, r = 0.73 (P < 0.0005). The QoR-40 and SF-36 done at three years after cardiac surgery demonstrated good internal consistency, QoR-40 alpha = 0.86 (P < 0.0005), SF-36 alpha = 0.91 (P < 0.0005). A poor quality recovery in the days after surgery can predict a poor QoL at three years after surgery. The QoR-40 is a valid and reliable measure of quality of recovery after surgery and anaesthesia. The QoR-40 is a useful, patient-oriented method of assessing recovery from anaesthesia and surgery.     

A comparison of patient self-administered and investigator-administered measurement of quality of recovery using the QoR-40

A 40-item questionnaire (the QoR-40) had been previously developed to measure five dimensions of quality of recovery after anaesthesia and surgery. Each of the 40 items is rated on a scale of 1 to 5, with a maximum score of 200. In this study we compared patient self-administered with investigator-administered QoR-40. We studied 62 postoperative patients within 48 hours of their surgery. Agreement between the two methods was analysed using the intraclass correlation coefficient, bias and limits of agreement. There was strong correlation between the investigator-administered and patient self-administered QoR-40 scores, intraclass correlation coefficient 0.86 (95% CI: 0.77 to 0.92), P<0.001. The bias and limits of agreement were 3.1 and -22 to 28, respectively. There were 10 (16%) patient self-administered questionnaires that were not completed at first attempt. The time to complete the questionnaire when investigator-administered was 253 (16) s [mean, (SD)], and on first attempt for patients was 362 (19) s, P<0.001. The QoR-40 is as valid measure of postoperative recovery when administered with the assistance of an investigator as compared with the patient self-administered version. Investigator-administered measurement of the QoR-40 is a more efficient use of resources, as complete and more timely data are collected.     

Relation between quality of recovery in hospital and quality of life at 3 months after cardiac surgery

BACKGROUND: Improved quality of life (QoL) is a desirable outcome of cardiac surgery. The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later. METHODS: After obtaining ethics committee approval and consent, 120 adult cardiac surgical patients were studied. A 40-item quality of recovery score (QoR-40) was used to measure postoperative health status on days 1-3 and 1 month after surgery. QoL was measured using the short-form health survey (SF-36) at 1 and 3 months after surgery. The effect size (delta mean/SD) was used to define responsiveness, a clinically important difference in health. Associations were measured using correlation and reliability coefficients. RESULTS: There was a significant change in the mean QoR-40 for up to 1 month after surgery (P < 0.0005). QoL was improved at 3 months (P < 0.0005) but not 1 month (P = 0.29) after surgery. There was a moderate correlation between day-3 QoR-40 and 3-month SF-36 (r = 0.39; P < 0.0005). A poor-quality recovery in hospital predicted a poor QoL at 3 months (adjusted odds ratio, 4.20; 95% confidence interval, 1.41-12.5; P = 0.01). CONCLUSIONS: The QoR-40 is a valid measure of quality of recovery after surgery and anesthesia. When compared with the SF-36, it is a better measure of early postoperative recovery. A poor-quality recovery on the days after surgery can predict a poor QoL at 3 months after surgery. This may allow earlier and more effective support strategies while patients are still in the hospital (counseling, home assistance, local doctor notification, cardiac rehabilitation).     

Quality of Recovery from Anesthesia in Neurosurgical Patients

Background: Factors influencing quality of recovery in cranial and spinal neurosurgical patients are not known, possibly because of lack of a suitable instrument. Therefore, the authors measured quality of recovery using the QoR-40 score (a 40-item questionnaire on quality of recovery from anesthesia).

Methods: With informed consent, 200 patients undergoing elective neurosurgery were recruited. The QoR-40 score, visual analog scores for pain and quality of recovery, and data on complications were collected over 90 days. The psychometrics of the QoR-40 were tested and regression models were developed to determine predictors of quality of recovery and postoperative pain.

Results: The QoR-40 score demonstrated significant responsiveness, validity, and reliability. In cranial surgery patients, QoR-40 scores were lower on days 1 and 2 than either preoperatively or on days 3, 30, and 90. In spinal surgery patients, QoR-40 scores were lower preoperatively and on days 1 and 2 than on days 3, 30, and 90. Longer duration of surgery, more complications, and higher visual analog scores for pain were predictors of poor quality of recovery on day 3. Cranial surgery patients had moderately severe pain on days 1 and 2, whereas spinal surgery patients reported moderate pain for the whole study period. Neurologic deficits were negatively correlated with QoR-40 scores in cranial and spinal surgery patients.     

Relation between Quality of Recovery in Hospital and Quality of Life at 3 Months after Cardiac Surgery

Background: Improved quality of life (QoL) is a desirable outcome of cardiac surgery. The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later.

Methods: After obtaining ethics committee approval and consent, 120 adult cardiac surgical patients were studied. A 40-item quality of recovery score (QoR-40) was used to measure postoperative health status on days 1-3 and 1 month after surgery. QoL was measured using the short-form health survey (SF-36) at 1 and 3 months after surgery. The effect size ([DELTA]mean/SD) was used to define responsiveness, a clinically important difference in health. Associations were measured using correlation and reliability coefficients.

Results: There was a significant change in the mean QoR-40 for up to 1 month after surgery (P < 0.0005). QoL was improved at 3 months (P < 0.0005) but not 1 month (P = 0.29) after surgery. There was a moderate correlation between day-3 QoR-40 and 3-month SF-36 (r = 0.39;P < 0.0005). A poor-quality recovery in hospital predicted a poor QoL at 3 months (adjusted odds ratio, 4.20; 95% confidence interval, 1.41-12.5;P = 0.01).     

Quality of recovery from anesthesia in neurosurgical patients

BACKGROUND: Factors influencing quality of recovery in cranial and spinal neurosurgical patients are not known, possibly because of lack of a suitable instrument. Therefore, the authors measured quality of recovery using the QoR-40 score (a 40-item questionnaire on quality of recovery from anesthesia). METHODS: With informed consent, 200 patients undergoing elective neurosurgery were recruited. The QoR-40 score, visual analog scores for pain and quality of recovery, and data on complications were collected over 90 days. The psychometrics of the QoR-40 were tested and regression models were developed to determine predictors of quality of recovery and postoperative pain. RESULTS: The QoR-40 score demonstrated significant responsiveness, validity, and reliability. In cranial surgery patients, QoR-40 scores were lower on days 1 and 2 than either preoperatively or on days 3, 30, and 90. In spinal surgery patients, QoR-40 scores were lower preoperatively and on days 1 and 2 than on days 3, 30, and 90. Longer duration of surgery, more complications, and higher visual analog scores for pain were predictors of poor quality of recovery on day 3. Cranial surgery patients had moderately severe pain on days 1 and 2, whereas spinal surgery patients reported moderate pain for the whole study period. Neurologic deficits were negatively correlated with QoR-40 scores in cranial and spinal surgery patients. CONCLUSIONS: The QoR-40 score is a useful instrument with which to assess quality of recovery in cranial and spinal surgery patients. Postoperative pain and neurologic deficits correlate with poor quality of recovery in these patients.     

Systematic review of the QoR-15 score,a patient- reported outcome measure measuring quality of recovery after surgery and anaesthesia

Background

The QoR-15 is a patient-reported outcome questionnaire that measures the quality of recovery after surgery and anaesthesia. We aimed to perform a systematic review and meta-analysis of the measurement properties of the QoR-15.

Effects of Preoperative Oral Carbohydrates on Quality of Recovery in Laparoscopic Cholecystectomy: A Randomized,Double Blind,Placebo-Controlled Trial

Background

While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC.

Methods

A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400 mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400 mL was ingested at least 2 h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated.

Results

There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P?=?0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P?=?0.0412).

Conclusions

The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8 h.

Trial Registration

Clinical trial.gov identifier: NCT02555020.

     

单次亚麻醉剂量氯胺酮对结直肠肿瘤患者术后早期情绪反应的影响

目的观察单次亚麻醉剂量氯胺酮对结直肠肿瘤患者术后焦虑、抑郁等情绪反应的影响。方法选择42例择期全麻下行结直肠肿瘤切除患者,年龄18~65岁,随机分为氯胺酮组(K组)和对照组(C组)。全麻诱导后K组于手术开始前5min单次静注氯胺酮0.3mg/kg,C组给予等量生理盐水,术后两组患者静脉镇痛方案相同。手术前1d及术后48h内使用医院焦虑抑郁量表(HAD)评估患者情绪反应(焦虑、抑郁状态),使用QoR-40调查问卷评估术后恢复情况,拔管后30min测定VAS疼痛评分和Ramsay镇静评分,并记录麻醉结束至拔管的时间、拔管时呛咳、苏醒期躁动及谵妄、拔管后30min内不良反应发生情况。结果术后48hK组患者焦虑评分(HAD-A)、抑郁评分(HAD-D)均明显低于C组(P0.05)。术后48h两组患者QoR-40评分差异无统计学意义。术后48hK组患者QoR-40评分明显高于C组(P0.05)。拔管后30min K组患者VAS疼痛评分明显低于C组(P0.05),两组Ramsay镇静评分差异无统计学意义。两组患者拔管时间、拔管后呛咳、苏醒期躁动及谵妄发生率差异均无统计学意义。拔管后30min未见头晕、恶心、呕吐、复视等不良反应。结论单次亚麻醉剂量氯胺酮可降低结直肠肿瘤患者术后焦虑、抑郁评分并改善术后苏醒质量,未增加不良反应。     

Measuring the quality of life in patients with venous ulcers

PURPOSE: This prospective study aimed to validate a newly designed specific measure of quality of life for patients with venous ulcers. METHODS: The study was set in a London teaching hospital and surrounding community clinics. Items for the questionnaire were selected by means of patient interviews, a literature review, and expert opinion. The questionnaire and the Short Form 36-item (SF-36) Health Survey were given to a prospective consecutive cohort of 98 patients with proven venous ulcers that were diagnosed by means of clinical and color duplex examination. Fifty-eight of the patients were women (60%), and the median age of patients was 76 years. The questionnaire was assessed for reliability, validity, and responsiveness. RESULTS: The ulcer-specific questionnaire showed good reliability, as assessed by means of the internal consistency (Cronbach alpha = 0.93) and test-retest analysis (r = 0.84). Factor analysis identified four important health factors: social function, domestic activities, cosmesis, and emotional status. Validity was demonstrated by means of a high correlation with all eight domains of the SF-36 general health measure (r > 0.55, P <.001). Responsiveness was demonstrated by means of a significant reduction in the score on the ulcer questionnaire as ulcers healed at 6 and 11 weeks (P <.05). CONCLUSION: Good evidence exists that a clinically derived measure for patients with venous ulcers has validity to measure the quality of life.     

Impact of ultrasound-guided erector spinae plane block on postoperative quality of recovery in video-assisted thoracic surgery: A prospective,randomized, controlled trial

Study objectiveRegional anesthesia improves postoperative analgesia and enhances the quality of recovery (QoR) after surgery. We examine the efficacy of ultrasound-guided erector spinae plane block (ESPB) on QoR after video-assisted thoracic surgery (VATS).DesignProspective, randomized, double-blinded, placebo-controlled trial.SettingSingle institution, tertiary university hospital.PatientsAdult patients who scheduled for VATS under general anesthesia were enrolled in the study.InterventionsWe randomly allocated patients to receive preoperative ultrasound-guided ESPB with 25 ml of either 0.5% ropivacaine (ESPB group) or normal saline (Control group).MeasurementsThe primary outcome was QoR as measured by the 40-item QoR questionnaire (QoR-40) score at postoperative day 1. Secondary results were post-anesthesia care unit (PACU) discharge time, acute postoperative pain, cumulative opioid consumption, the incidence of postoperative nausea or vomiting (PONV), and patient satisfaction.Main resultsThe global QoR-40 score at postoperative day 1 (median, interquartile range) was significantly higher in the ESPB group (174, 170 to 177) than the control group (161.5, 160 to 165), estimated median difference 11 (95% CI 9 to 13, P < 0.001). Compared with the control group, single-injection of ESPB reduced PACU discharge time, acute postoperative pain, and cumulative opioid consumption. Correspondingly, the median patient satisfaction scores were higher in the ESPB group than the control group (9 versus 7, P < 0.001).ConclusionPreoperative single-injection thoracic ESPB with ropivacaine improves QoR, postoperative analgesia, and patient satisfaction after VATS.     

Measurement of quality of recovery in 5672 patients after anaesthesia and surgery

Quality of recovery after an operation is an important dimension of the patient's experience and may be related to the quality of anaesthesia care. Satisfaction with anaesthesia is a vital component of quality care but difficult to measure. We examined our database of 5672 adult patients to determine if quality of recovery is associated with satisfaction with anaesthesia and to identify the perioperative factors that might influence both these outcome measures. We found that a nine-item quality of recovery score ("QoR Score") was related to satisfaction with anaesthesia (P < 0.0005): the overall level of satisfaction was high (97.2%; median QoR Score 16); 106 patients (2.1%; median QoR Score 14) were "somewhat dissatisfied" and 32 patients (0.6%; median QoR Score 13) were "dissatisfied" with their anaesthesia care. Patients who experienced any of a number of perioperative complications had lower QoR Scores (P < 0.0005). We have further demonstrated the validity and clinical utility of the QoR Score, and in particular, its relationship to patient satisfaction in adult surgical patients.     

Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure

PURPOSE: We developed the ureteral stent symptom questionnaire (USSQ), a psychometrically valid measure to evaluate symptoms and impact on quality of life of ureteral stents. MATERIALS AND METHODS: A total of 309 patients were asked to participate during different phases of our study. In phase 1 a structured literature search, 9 patient interviews and studies of 90 patients using existing instruments formed the foundation for the initial draft of our new questionnaire. In phase 2 the USSQ was pilot tested, reviewed by experts and field tested in 40 patients to produce a final 38-item draft. In phase 3 formal validation studies were performed in 55 patients to assess validity, reliability and sensitivity to change. Discriminant validation was performed by administering the questionnaire to 3 groups of patients without stents. RESULTS: The final draft addressed various domains of health (6 sections and 38 items) affected by stents covering urinary symptoms, pain, general health, work performance, sexual matters and additional problems. The validation studies showed the questionnaire to be internally consistent (Cronbach's alpha > 0.7) with good test-retest reliability (Pearson's coefficient > 0.84). The questionnaire demonstrated good construct validity and sensitivity to change shown by significant changes in the score with and after removal of stents. The new USSQ discriminated patients with stents from healthy controls (p < 0.001) and patients with urinary calculi without stents and lower urinary tract symptoms. CONCLUSIONS: Indwelling ureteral stents have a significant impact on health related quality of life. The new USSQ is a valid and reliable instrument that is expected to become a standard outcome measure to evaluate the impact and compare different types of stents.     

Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity

Patient-orientated assessment methods are of paramount importance in the evaluation of treatment outcome. The Oswestry Disability Index (ODI) is one of the condition-specific questionnaires recommended for use with back pain patients. To date, no German version has been published in the peer-reviewed literature. A cross-cultural adaptation of the ODI for the German language was carried out, according to established guidelines. One hundred patients with chronic low-back pain (35 conservative, 65 surgical) completed a questionnaire booklet containing the newly translated ODI, along with a 0-10 pain visual analogue scale (VAS), the Roland Morris Disability Questionnaire, and Likert scales for disability, medication intake and pain frequency [to assess ODI's construct (convergent) validity]. Thirty-nine of these patients completed a second questionnaire within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient for the test-retest reliability of the questionnaire was 0.96. In test-retest, 74% of the individual questions were answered identically, and 21% just one grade higher or lower. The standard error of measurement (SEM) was 3.4, giving a "minimum detectable change" (MDC(95%)) for the ODI of approximately 9 points, i.e. the minimum change in an individual's score required to be considered "real change" (with 95% confidence) over and above measurement error. The ODI scores correlated with VAS pain intensity (r = 0.78, P < 0.001) and Roland Morris scores (r = 0.80, P < 0.001). The mean baseline ODI scores differed significantly between the surgical and conservative patients (P < 0.001), and between the different categories of the Likert scales for disability, medication use and pain frequency (in each case P < 0.001). Our German version of the Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as, if not better than, the original English version. It should represent a valuable tool for use in future patient-orientated outcome studies in German-speaking lands.     

Quality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. Prospective randomized clinical trial

Study objectivesThe aim of the present study was to assess the quality of recovery from anesthesia of patients subjected to otorhinolaryngological (ORL) surgery under balanced or total intravenous general anesthesia by means of Quality of Recovery-40 (QoR-40) questionnaire.DesignProspective randomized clinical trial.SettingThe setting is at an operating room, a postoperative recovery area, and a hospital ward.PatientsOne-hundred thirty American Society of Anesthesiologists physical status I or II patients scheduled to undergo general anesthesia for ORL interventions under remifentanil, in combination with sevoflurane (balanced technique) or propofol (total intravenous anesthesia).MeasurementsOccurrence of nausea, vomiting, body temperature less than 36°C, and length of stay in the postanesthesia care unit were recorded. The QoR-40 was administered by an investigator blind to group allocation 24 hours after surgery. The quality of recovery, as assessed by the score on the QoR-40, was compared between the groups.Main resultsThere is no difference regarding the QoR-40 score among intravenous and inhalation anesthesia groups (190.5 vs 189.5, respectively; P = .33). Similarly, among the 5 dimensions of the QoR-40, the scores were comparable between the groups. Incidence of hypothermia (P = .58), nauseas or vomits (P = .39), and length of surgery (P = .16) were similar among groups. The evaluation of pain intensity (P = .80) and dose of morphine use in the postanesthesia care unit (P = .4) was also comparable between groups.ConclusionsThe quality of recovery from anesthesia assessed based on the patients' perception did not differ between the ones subjected to either inhalation or intravenous general anesthesia for ORL surgery based on QoR-40 questionnaire assessment.     

右美托咪定对硅胶囊隆乳术患者术后早期情绪反应的影响

目的探讨右美托咪定对硅胶囊隆乳术患者术后早期情绪反应的影响。方法60例择期全身麻醉下行硅胶囊隆乳术患者,ASA分级I、Ⅱ级,年龄18～48岁。麻醉诱导和维持分别采用右美托咪定组（A组）和丙泊酚组（B组）。同时均吸入七氟烷,术后两组患者静脉镇痛用药方案相同。术前1d及术后48h内,使用医院焦虑抑郁量表（HAD）评估患者情绪反应（虑、抑郁状态）,使用QoR-40调查问卷评估术后恢复情况,术后30min,采用视觉模拟评分法（VAS）测定疼痛程度,采用Ramsay法评估镇静程度,并记录所有患者麻醉结束至拔管的时间,拔管时呛咳,苏醒期躁动谵妄,术后30rain内镇静、头晕、恶心、呕吐、复视、幻觉等不良反应情况。结果A组患者术后48h医院焦虑抑郁量表焦虑（HAD—A）评分、抑郁（HAD—D）评分均低于B组,差异有统计学意义（P〈0．05）;术后48h两组患者QoR40总分无统计学意义（P〉0．05）,但A组患者术后48hQoR-40情绪状态评分高于B组（P〈0．05）;A组患者拔管后30nlin时疼痛VAS评分低于B组（P〈0．05）,术后30rain镇静评分两组患者无统计学意义（P〉0．05）;两组患者麻醉后拔管时间、拔管后呛咳、苏醒期躁动及谵妄发生率均无统计学意义（P〉0．05）。术后30min内未见头晕、恶心、呕吐、复视等不良反应发生。结论右美托咪定可降低硅胶囊隆乳术患者手术后早期（48h内）医院焦虑抑郁量表焦虑评分（HAD—A）、抑郁评分（HAD—D）及QoR40情绪状态评分,减轻患者拔管后30min时疼痛VAS评分。提示右美托咪定可改善硅胶囊隆乳术患者全身麻醉手术后早期焦虑／抑郁情绪反应,提高术后恢复质量,有利于促进患者术后早期康复。     

Pre-emptive multimodal analgesic bundle with transversus abdominis plane block enhances early recovery after laparoscopic cholecystectomy

BackgroundAs postoperative pain after laparoscopic cholecystectomy may delay recovery and discharge, a multimodal and pre-emptive analgesic approach is necessary. This study demonstrated that a multimodal analgesic bundle improves postoperative recovery, using the Quality of Recovery-40K (QoR-40K) questionnaire during the first 24 h after laparoscopic cholecystectomy.MethodsIn this prospective non-randomized study with two parallel groups, 80 patients undergoing laparoscopic cholecystectomy were allocated into either the multimodal analgesia group or the conventional analgesia group. The multimodal analgesia group received a pre-emptive analgesic bundle (preoperative intravenous administration of paracetamol, ketorolac, and dexamethasone, and a posterior approach to the transversus abdominis plane block), while the conventional analgesia group did not. The primary outcome was the QoR-40K score during the first 24 h after surgery. Secondary outcomes were the peak visual analog scale pain score at rest and the incidence rates of rescue analgesic use and nausea/vomiting during the first 24 h after surgery.ResultsThe QoR-40K score was higher in the multimodal analgesia group than in the conventional analgesia group (196 [190–199] vs. 182 [172–187], p < 0.001). The peak visual analog scale pain score was significantly lower in the multimodal analgesia group than in the conventional analgesia group. Multimodal analgesia also reduced the incidence rates of rescue analgesic use and postoperative nausea/vomiting (22.5% [95% CI, 9.6–35.4%] vs. 55.0% [39.6–70.4%], p = 0.003), compared to conventional analgesia.ConclusionsMultimodal analgesia significantly improves the quality of early postoperative recovery after laparoscopic cholecystectomy, as shown by the QoR-40K score.     

罗哌卡因复合布托啡诺腹横肌平面阻滞对妇科腹腔镜手术患者术后镇痛及早期康复的影响

目的评价罗哌卡因复合布托啡诺腹横肌平面(transversus abdominis plane,TAP)阻滞对妇科腹腔镜手术患者术后镇痛及早期康复的影响。方法择期全麻下行妇科腹腔镜手术患者60例,年龄18~65岁,体重50~76 kg,ASAⅠ或Ⅱ级,采用随机数字表法将患者随机分为两组:罗哌卡因复合布托啡诺组(BR组)和罗哌卡因组(R组),每组30例。所有患者在麻醉诱导后均行双侧TAP阻滞。BR组患者每侧注入0.375%罗哌卡因20 ml+0.1%布托啡诺1 ml,R组患者每侧注入0.375%罗哌卡因20 ml+生理盐水1 ml。记录患者术中丙泊酚及瑞芬太尼用量、术后2、24 h的VAS疼痛评分、术后肠道功能恢复时间、下床活动时间、术后24 h的40项恢复质量(quality of recovery,QoR-40)评分。记录TAP阻滞有关不良反应和术后恶心呕吐的发生情况。结果与R组比较,BR组术中瑞芬太尼用量明显减少(P<0.05),术后2 h的VAS疼痛评分明显降低(P<0.05),术后24 h的QoR-40评分明显升高(P<0.05)。两组术中丙泊酚用量、术后肠道功能恢复时间、下床活动时间、术后恶心呕吐发生率差异无统计学意义。两组均无一例TAP阻滞有关不良反应发生。结论罗哌卡因复合布托啡诺用于腹横肌平面阻滞可减少术中瑞芬太尼用量,改善术后疼痛,提高患者术后麻醉恢复质量。     

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.     

Early quality of recovery according to QoR-15 score is associated with one-month postoperative complications after elective surgery

Study objectiveThe QoR-15 scale is a validated tool to assess the quality of postoperative recovery (QoR). Our objective was to assess the association between the early QoR-15 values and the occurrence of one-month postoperative complications.DesignWe used the data from a prospective single-centre cohort study conducted in the Angers University Hospital from July 2019 to February 2020 that validated the French version of the QoR-15 (FQoR-15).SettingPreoperative room, ward, and home.Patients363 French-speaking adult patients, undergoing elective surgery, were enrolled (217 (59,8%) men, median age 60 (range 44 to 71) years old), including 139 (38.3%) ambulatory surgeries.InterventionPatients completed the QoR-15 scale the day before, at 24 and 48 h after surgery.MeasurementsPostoperative complications were recorded according to the PostOperative Morbidity Survey (POMS) classification till 30 days after surgery. The QoR was classified as excellent (QoR-15 > 135), good (122 ≤ QoR-15 ≤ 135), moderate (90 ≤ QoR-15 ≤ 121) or poor (QoR-15 < 90). Days alive and out of hospital up to 30 days after surgery was also recorded.Main resultsAccording to the POMS classification, 176 (48.5%) patients had at least one complication up to 30 days after surgery. Among the 69 (19.0%) patients with a poor recovery at H24, 58 (84.1%) had at least one complication up to 30 days after surgery compared to 10 (23.8%) among the 42 (11.6%) in the excellent recovery group (p < 0.0001). The QoR-15 score at H24 allowed suitable discrimination of the occurrence of at least one complication up to 30 days after surgery (AUC 0.732 (95% CI 0.680 to 0.784)).ConclusionThe early QoR-15 scale after surgery is moderately associated with the occurrence of postoperative complications up to 30 days after elective surgeries (i.e. it has predictive validity).