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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23083    [Epub ahead of print]
Published online May 26, 2023.
Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy
Hyun-Kyu Yoon1,2, Somin Joo1, Susie Yoon1,2, Jeong-Hwa Seo1,2, Won Ho Kim1,2, Ho-Jin Lee1,2
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Corresponding author:  Ho-Jin Lee, Tel: 82-2-2072-2467, Fax: 82-2-747-8363, 
Email: zenerdiode03@gmail.com
Received: 3 February 2023   • Revised: 21 May 2023   • Accepted: 25 May 2023
We compared the effect of general anesthetics on postoperative quality of recovery between propofol-based total intravenous anesthesia (TIVA) and inhalation anesthesia.
In this randomized trial, 150 patients undergoing robot-assisted or laparoscopic nephrectomy for renal cancer were randomly allocated to either the TIVA or desflurane anesthesia (DES) group. Postoperative recovery was evaluated using the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K) at 24 h, 48 h, and 72 h postoperatively. A generalized estimating equation (GEE) was performed to analyze longitudinal QoR-15K data. Opioid consumption, pain severity, postoperative nausea and vomiting, and quality of life three weeks after discharge were also compared.
Data were analyzed for 70 patients in each group. The TIVA group showed a significantly higher QoR-15K score at 24 and 48 h postoperatively (24 h: DES, 96 [77–109] vs. TIVA, 104 [82–117], median difference 8 [95% CI: 1–15], P=0.029; 48 h: DES, 110 [95–128] vs. TIVA, 125 [109–130], median difference 8 [95% CI: 1–15], P=0.022), however not at 72 h (P=0.400). The GEE revealed significant effects of group (adjusted mean difference 6.2, 95% CI: 0.39–12.1, P=0.037) and time (P<0.001) on postoperative QoR-15K scores without group-time interaction (P=0.051). However, there were no significant differences at other time points and in other postoperative outcomes, except opioid consumption, during the first 24 h postoperatively.
Propofol-based TIVA showed only a transient improvement in postoperative recovery than desflurane anesthesia, not leading to significant differences in other postoperative outcomes.
Key Words: Anesthetics, general; Anesthesia, Inhalation; Anesthesia, Intravenous; Enhanced recovery after surgery; Perioperative medicine; Postoperative Period
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