Improving quality of recovery: what anaesthetic techniques make a difference?

Practising evidence-based medicine in anaesthesia can be difficult. Minor, transient complications are common after anaesthesia and surgery and these may or may not have a significant effect on patient outcome, including overall quality of recovery. Most anaesthesia research does not provide reliable information about effective interventions. Nevertheless, good quality evidence from randomized trials and systematic reviews is available, and their uptake into clinical practice should reduce serious or permanent complications. Most patients do not suffer major complications and so their quality of recovery needs to be defined in other ways and this should be assessed from the patient's perspective. Thus, a good outcome can be defined by avoidance of major complications and the experience of a good quality recovery. Changes in clinical practice should be evidence-based and this requires the conduct of good quality clinical research, including large trials. This paper identifies some anaesthetic techniques that do make a difference; these should be part of routine practice.