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PURPOSE: The Quality of Recovery-15 (QoR-15) tool, validated for measuring postoperative recovery following scheduled surgeries, has not been psychometrically assessed in emergency contexts. Moreover, the QoR-15s associations with long-term outcomes remain underexplored. This study aimed to confirm the validity and reliability of the QoR-15 following emergency surgery and assess its association with three-month postoperative quality of life. METHODS: We conducted a prospective cohort study (August 2021-April 2022) on adult patients who underwent emergency surgery. The QoR-15 questionnaire was administered before surgery (H0) and at 24 hr (H24) and 48 hr (H48) after surgery. We examined the H24 scores associations with both the three-month quality of life, as assessed by the EQ-5D scale, and the number of days spent at home at 30 (DAH30) and 90 (DAH90) days. RESULTS: Of the 375 included patients, 352 (94%) completed the QoR-15 at H24 and 338 (90%) were followed up at three months. The population represented the following diverse surgical specialties: orthopedic (51%), gastrointestinal (27%), urologic (13%), and others (9%). The QoR-15 questionnaire confirmed all psychometric qualities (internal consistency, reproducibility, responsiveness, acceptability, construct, and convergent validities) in the emergency context. The average minimum clinical difference was 8.0 at H24. There was an association between QoR-15 at H24 and the three-month quality of life (r = 0.24; 95% confidence interval [CI], 0.14 to 0.34; P

This meta-analysis investigated the effects of intravenous magnesium sulfate on the postoperative recovery quality, as assessed using the Quality of Recovery (QoR) questionnaire, in adult surgical patients. Seven randomized controlled trials involving 622 patients were included. Compared with the placebo, magnesium sulfate significantly improved the global QoR score on postoperative day 1 (standardized mean difference [SMD]: 1.24; 95% confidence interval: 0.70—1.78; p < 0.00001). It also enhanced specific QoR dimensions, with substantial effects on pain (SMD: 1, p < 0.00001) and physical comfort (SMD: 0.85, p < 0.0001), a moderate effect on emotional state (SMD: 0.65, p = 0.002), and small improvements in physical independence (SMD: 0.43, p < 0.00001) and psychological support (SMD: 0.37, p < 0.0001). In addition, magnesium sulfate reduced the intraoperative opioid consumption (SMD: −0.66, p < 0.0001), postoperative pain severity, and the incidence of postoperative nausea and vomiting (risk ratio: 0.48, p = 0.008). The extubation times were unaffected, whereas the post-anesthesia care unit stay was slightly prolonged. These findings highlight the potential of magnesium sulfate as a valuable adjunct for multimodal analgesia and enhanced recovery. Future studies should aim to elucidate the optimal dosing strategies, timing of administration, and specific surgical populations that may derive maximum benefits. [ABSTRACT FROM AUTHOR]

Abstract Background The efficacy and reliability of erector spinae plane block (ESPB) in posterior open lumbar spine surgery has been demonstrated; however, few randomized controlled trials of lumbar ESPB (L-ESPB) in lumbar unilateral bi-portal endoscopic (UBE) surgery have been reported. Methods A total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores. Results Compared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference − 280 mcg, 95% confidence interval [CI] − 360 to − 200, p

BackgroundPain is frequent after cardiac surgery and source of multiple complications that can impair postoperative recovery. Regional anesthesia seems to be an interesting technique to reduce the pain in this context, but its effectiveness in improving recovery has been poorly studied so far. The objective of this study is to compare the effectiveness of two of the most studied chest wall blocks in cardiac surgery, i.e., the superficial and the deep parasternal intercostal plane blocks (SPIP and DPIP respectively), in addition to standard care, versus the standard care without regional anesthesia, on the quality of postoperative recovery (QoR) after cardiac surgery with sternotomy.MethodsThis is a single-center, single-blind, controlled, randomized trial with a 1:1:1 ratio. Patients (n = 254) undergoing cardiac surgery with sternotomy will be randomized into three groups: a control group with standard care and no regional anesthesia, a SPIP group with standard care and a SPIP, and a DPIP with standard care and a DPIP. All groups will receive the usual analgesic protocol. The primary endpoint is the value of the QoR evaluated by the QoR-15 at 24 h after the surgery.DiscussionThis study will be the first powered trial to compare the SPIP and the DPIP on global postoperative recovery after cardiac surgery with sternotomy.Trial registrationClinicalTrials.gov NCT05345639. Registered on April 26, 2022.

Cen Cheng, Jingjing Wang, Yuanyuan Cao, Erwei Gu, Xuesheng Liu Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of ChinaCorrespondence: Xuesheng Liu, Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email liuxuesheng@ahmu.edu.cnIntroduction: Rectus sheath block is an emerging technique that provide effective perioperative analgesia and is related to lower perioperative opioid consumption and decrease opioid-related adverse effects. The present research is designed to explore the effect of rectus sheath block on recovery quality in patients following transabdominal midline gynecological surgery.Methods: Ninety female patients following elective transabdominal midline gynecological surgery were enrolled. Patients were randomized to group R (n = 45) which receive preoperative ultrasound-guided RSB with 0.4% ropivacaine or group C which is control group (n = 45). The primary outcome was the quality of recovery on the first postoperative day. The quality of recovery was assessed by the 40-item Quality of Recovery questionnaire (QoR-40). Secondary outcomes included the intraoperative opioid consumption, time to first flatus and time to first discharging from bed, postoperative nausea and vomiting, and patient satisfaction.Results: The patients in two groups had comparable baseline characteristics. Postoperative global QoR-40 scores were significantly better in group R than in group C (165.0[159.5-170.0] vs 155.0[150.0-157.0], respectively; median difference 12[95% confidence interval: 8-15, P< 0.001]). Preoperative RSB reduced intraoperative opioid consumption, reduced the time to first flatus, time to first discharging from bed and the post anaesthesia care unit discharge time. Furthermore, group R showed greater patient satisfaction.Conclusion: A single preoperative administration of RSB with ropivacaine improved the quality of recovery in patients following transabdominal midline gynecological surgery.Plain Language Summary: Although laparoscopic surgery accounts for a higher proportion of gynecological procedures, open gynecological surgery remains irreplaceable for some patients. Recovery from open gynecological surgery is a combination of physical injuries and psychological challenges. Consequently, accelerating functional recovery, alleviating discomfort and improving the quality of recovery in such patients is a clinical issue that we need to focus on. The QoR 40 scale is a patient-reported assessment tool which evaluates the quality of recovery in five dimensions.Ultrasound-guided rectus sheath block is a safe and effective abdominal wall nerve block for anesthesia and analgesia of umbilical and median abdominal longitudinal incisions. This study investigated the impact of rectus sheath block on the quality of postoperative recovery after open gynecological surgery using the QoR40 scale. Participants were randomized to two groups: rectus sheath block treatments and a control group receiving standard care only.Rectus sheath block improves the quality of recovery in patients undergoing open gynecological surgery one day after surgery without adverse effects, which has successfully made rapid rehabilitation from bench to bedside.Keywords: rectus sheath block, quality of recovery, transabdominal midline gynecological surgery, QoR 40

Abstract Background Obese patients undergoing laparoscopic sleeve gastrectomy (LSG) are particularly at risk of opioid-related side effects. To reduce patient exposure to opioids, multimodal analgesia, which involves the use of drugs of different classes, may be utilized. One of the drugs under consideration is pregabalin. Despite an opioid-sparing potential, few studies assess the role of pregabalin as an element of multimodal analgesia in LSG. Considering the limited number and inconsistent results of available studies, we decided to conduct a randomized, prospective study on the effect of preemptive pregabalin administration in obese patients on opioid consumption, pain scores, the incidence of opioid side effects, and hemodynamical stability. Methods The study is designed as a prospective randomized controlled trial with double-blinding. Randomization will be performed in a block with a parallel 1:1 allocation. The intervention will involve receiving a pregabalin 150 mg capsule 1–2 h before the surgery, whereas the control group will receive an identically looking placebo. The primary outcome measure will be total oxycodone consumption in the first 24 h following surgery. Secondary outcome measures will be pain severity assessed using the Numerical Rating Scale (NRS) 1, 6, 12, and 24 h after surgery, postoperative sedation on the Ramsay scale, PONV impact scale, the incidence of desaturation episodes

Lijuan Zhang,1 Zhe Wang,2 Yingge Liu,1 Xiaobao Zhang,1 Yong Wu1 1Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of ChinaCorrespondence: Yong Wu, Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, No. 6 East Zhenhua Road, Lianyungang, Jiangsu, 222061, People’s Republic of China, Tel +8618961325621, Email 18961325621@163.comPurpose: Remimazolam tosilate is a novel ultrafast-acting benzodiazepine that has a rapid emergence even after continuous infusion when using flumazenil. So far, relatively few articles are still focusing on the quality of recovery after general anesthesia with remimazolam, especially in day surgery. This study aimed to compare the early postoperative quality of recovery of remimazolam tosilate with flumazenil and propofol in patients undergoing day surgery.Patients and Methods: 137 patients scheduled for day surgery were randomly divided into the remimazolam tosilate or propofol group. The primary endpoint was the incidence of overall recovery assessed with the early postoperative quality of recovery scale (PostopQRS) on postoperative day 1 (POD 1). The Richmond Agitation-Sedation Scale (RASS) scores in the post-anesthesia care unit (PACU), extubation time, postoperative recovery profiles, and perioperative data were documented. Any adverse events were recorded.Results: The incidence of overall recovery on POD1 was 47.7% in the remimazolam tosilate group and 65.1% in the propofol group (odds ratio, 0.52; 95% confidence interval (CI) 0.26 to 1.06; P = 0.072). In general, the overall recovery of the PostopQRS increased over time, and its interaction between time and group was significant (P = 0.003). Among the five dimensions of PostopQRS, there exist statistical differences between groups including emotional state and cognitive recovery. Upon arrival at the PACU, the remimazolam group was more sedated and took longer to recover to a RASS score similar to propofol. The frequency of application of vasoactive drugs during anesthesia was similar in both groups (P = 0.119). Despite rapid emergence with remimazolam after flumazenil reversal, re-sedation (10.8%) or somnolence (60%) in the PACU was observed, and the length of PACU stay in patients treated with remimazolam tosilate was longer than that of the propofol (35 min vs 30 min, P< 0.001).Conclusion: General anesthesia with remimazolam tosilate in conjunction with flumazenil reversal permits rapid recovery of consciousness in day surgery, but there was a notable occurrence of re-sedation or somnolence observed in PACU.Keywords: remimazolam tosilate, flumazenil, propofol, day surgery, quality of recovery

Background: Patient-centered outcome measures should be evaluated postoperatively as the recovery after surgery varies between patients. We aimed to evaluate the feasibility, reliability, and trajectory of the quality of recovery-15 (QoR-15) in patients undergoing cardiothoracic and aortic surgeries. Materials and Methods: This retrospective study included adult patients who underwent elective cardiothoracic and aortic surgeries. The primary outcome was the QoR-15, with a minimal clinically important difference of 6.8, assessed on postoperative days (POD) 2, 4, and 7. The final analysis included patients with at least one valid outcome. Feasibility and reliability were assessed by the successful completion rate on each POD and using Cronbach’s alpha of the QoR-15 on POD 4. A linear mixed model was used to evaluate the trajectory of the postoperative QoR-15 scores. Results: Of the 36 eligible patients, 30 with a mean age of 70 years were included in the final analysis. The successful completion rates on POD 2, 4, and 7 were 72.7%, 87.8%, and 87.8%, respectively. The mean QoR-15 scores on POD 2, 4, and 7 were 89.9, 98.0, and 108.3, respectively. The QoR-15 scores on POD 2 and 4 were not statistically different (P = 0.06) but were clinically significant. The QoR-15 score on POD 7 was statically (P < 0.001) and clinically higher than the QoR-15 score on POD 2. Cronbach’s alpha for the QoR-15 score measured on POD 4 was 0.85. Conclusion: The QoR-15 is a feasible and valid measurement after elective cardiothoracic surgery, which increases significantly over time after surgery.

Background Methods Discussion Trial Registration Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP.Adult patients scheduled for laparoscopic surgery undergo pain‐sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain‐sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain‐tolerant) are randomized to opioid‐free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery.Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain.Prospectively posted at ClinicalTrials.gov, identifier NCT04751812. [ABSTRACT FROM AUTHOR]

OBJECTIVES The goal of this study was to assess the safety and quality of recovery (QOR) after discharge on postoperative day (POD) 1 following subxiphoid thoracoscopic anatomical lung resection within an advanced Enhanced Recovery After Surgery (ERAS) program. METHODS A retrospective analysis of prospectively collected data was conducted. Characteristics, perioperative and outcome data, compliance with ERAS pathways and a home–transition QOR survey were analysed using a multivariable logistic regression model. RESULTS From January 2020 to January 2022, a total of 201 consecutive patients underwent subxiphoid multiportal thoracoscopic anatomical lung resection, comprising 108 lobectomies and 93 sublobar resections (SLRs) (59 complex SLRs and 34 simple SLRs). Among them, 113 patients (56%) were discharged on POD 1, 49% after a lobectomy, 59% after a simple sublobar resection and 68% after a complex sublobar resection. In the multivariable analysis, age > 74 years and duration of the operation were associated with discharge after POD 1, whereas forced expiratory volume in 1 s and complex SLRs were associated with discharge on POD 1. Chest tube removal was achieved on POD 0 in 58 patients (29%), and 138 patients (69%) were free from a chest tube on POD 1. There were 13% with in-hospital morbidity, 10% with 90-day readmission (7% after POD 1 discharge and 14% in patients discharged after POD 1), and 0.5% with 90-day mortality. Patients discharged on POD 1 showed better compliance with the ERAS pathway with early chest tube removal and opioid-free analgesia. The home–transition QOR survey reported a better experience of returning home after discharge on POD 1 and similar pain scores. CONCLUSIONS Postoperative day 1 discharge can be safely achieved in appropriately selected patients after subxiphoid thoracoscopic anatomical lung resection, with excellent outcomes and high quality of recovery, supported by early chest tube removal as a determinant ERAS pathway. [ABSTRACT FROM AUTHOR]

This meta-analysis aimed to evaluate the impact of ketamine/esketamine on postoperative subjective quality of recovery (QoR). MEDLINE, Embase, Cochrane library, and Google Scholar were searched for randomised controlled trials (RCTs) that examined the impacts of perioperative ketamine/esketamine use and postoperative QoR. The primary outcome was subjective QoR (QoR-9, QoR-15, QoR-40) on postoperative day (POD) 1–3, whereas the secondary outcomes included pain severity, anxiety scores, depression scores, risk of adverse events (i.e. nausea, vomiting, dizziness, drowsiness), and length of stay. The analysis included 18 RCTs (1554 participants; ketamine: seven trials, esketamine: 11 trials), of which 15 were conducted in China. Ketamine/esketamine improved the QoR scores on PODs 1 and 2 compared with the control (standardised mean difference [SMD]: 0.63, P <0.0001 for POD 1; SMD: 0.56, P =0.04 for POD 2), without beneficial effect on POD 3. Subgroup analyses revealed significant differences in QoR scores on POD 1 by regimen (SMD: esketamine 1.14, ketamine 0.01) and country (SMD: China 0.82, other countries −0.21). The emotional domain of QoR was improved from PODs 1 to 3, whereas the other domains were only improved on POD 1. Lower postoperative anxiety (SMD: −0.48, P =0.003) and depression (SMD: −0.72, P =0.001) scores were also observed with ketamine/esketamine use. Furthermore, pain severity was reduced on PODs 1 and 2, with no difference in the risk of adverse events or length of stay. This meta-analysis demonstrated that ketamine/esketamine use in the perioperative period is associated with improved early subjective QoR, pain severity, and psychological symptoms without an increase in the likelihood of adverse events. PROSPERO (CRD42023477580). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient‐reported postoperative outcomes. Methods: This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery‐15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability‐free survival, defined as a 12‐item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. Results: After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery‐15 score on postoperative day 2 (β = −2.67, 95% confidence interval −5.20, −0.15), 4 (β = −3.54, 95% confidence interval −5.77, −1.30) and 7 (β = −3.70, 95% confidence interval −5.75, −1.65). The adjusted odds ratio of the FFPQ score for disability‐free survival postoperatively was 0.66 (95% confidence interval 0.49–0.90). Conclusions: Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery‐15 scores and poor disability‐free survival. Geriatr Gerontol Int 2024; 24: 464–469. Patients with higher Fried Frailty Phenotype Questionnaire scores had lower postoperative Quality of Recovery‐15 scores and were unlikely to have disability‐free survival at 3 months postoperatively. Frailty assessment using the Fried Frailty Phenotype Questionnaire might assist geriatricians, surgeons and anesthesiologists in predicting postoperative recovery, underscoring the importance of preoperative frailty assessment. [ABSTRACT FROM AUTHOR]

Purpose: To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods: A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results: At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112–140) vs. 124 (111–142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion: In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of gender on dosage of remimazolam and quality of recovery in patients undergoing ambulatory arthroscopic surgery at 24 hours postoperatively. Methods Fifty patients who underwent elective arthroscopic meniscus repair in a daytime surgery center were divided into two groups according to gender: 25 males (group M) and 25 females (group F). The remimazolam dogages of loss of consciousness and anesthesia maintenance were recorded, and the effects of gender on the quality of recovery at 24 hours postoperatively and sleepquality were observed by using QoR-15 scale and Athens Insomnia Scale (AIS). Results The doses of remimazolam at the time of loss of consciousness and anesthesia maintenance for patients were (0.13 and 0.15) mg/kg and 0.80 (0.60 and 0.96) mg/ (kg·h) in group M, and 0.14 (0.12 and 0.16) mg/kg and 0.90 (0.79 and 1.12) mg/ (kg·h) in group F. There were no statistical differences in the doses of remimazolam between the two groups (P > 0.05). AIS scores did not differ on postoperative day one between the two groups (P > 0.05), but there was a statistically significant difference on final awakening earlier than expectation in the female patients (P < 0.05). Female patients had lower total QoR-15 scores and physiological comfort scores, and higher incidences of hypotension and PONV than male patients (P < 0.05). Conclusions Gender had no significant effects on dosage of remimazolam during anesthesia induction and anesthesia maintenance in the patients receiving daytime arthroscopy. Female patients had final awakening earlier than expectation, and male patients had higher quality of recovery at 24 hours postoperatively. [ABSTRACT FROM AUTHOR]

This study compared the overall postoperative recovery of patients who underwent total intravenous anesthesia with remimazolam or propofol, using the Quality of Recovery-15 questionnaire (QoR-15). Seventy-two patients who underwent spine surgery with intraoperative neurophysiological monitoring (IONM) were randomly categorized into the remimazolam group (group R) or propofol group (group P). On the first postoperative day, the QoR-15 scores for groups P and R were 114 and 112, respectively, indicating no significant difference (p = 0.691). Similarly, group–time interaction effects on QoR-15 scores were not significantly different. In the post-anesthesia care unit, the pain intensity at rest was notably higher in group P than in group R (3.0 [0.0] vs. 2.8 [0.5], respectively, p = 0.009). Although the intraoperative consumption of remifentanil was higher in group R (1452.4 µg vs. 2066.8 µg, respectively, p < 0.001), the intraoperative use of vasopressors was lower in group R (1705.6 µg vs. 286.1 µg, respectively, p < 0.001) compared to group P. Group R exhibited significantly lower variability in mean blood pressure over time compared to group P. Remimazolam was viewed as a promising intravenous agent for general anesthesia, showing potential to replace propofol in spine surgery with IONM, considering both recovery quality and intraoperative hemodynamic stability. [ABSTRACT FROM AUTHOR]

Background and Aims: Perioperative intravenous (IV) infusions of lidocaine and esketamine reduce postoperative pain, but there are few studies on the quality of recovery and patients' emotional states postoperatively. We aimed to explore the effects of perioperative IV lidocaine and esketamine on the quality of recovery and emotional state after thyroidectomy. Methods: In this randomised trial, 137 patients undergoing thyroidectomy were randomly assigned to three groups: a lidocaine group (Group L), an esketamine group (Group E) and a normal saline placebo group (Group C). The primary outcome was the Quality of Recovery 40 (QoR-40) on postoperative days (PODs) 1 and 2. The secondary outcomes included Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores on days 1 and 2 after surgery, pain scores, opioid consumption and incidence of postoperative nausea and vomiting (PONV). Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis and Chi-square tests. Results: The global QoR-40 scores in groups L and E on POD 1 and POD 2 were significantly higher than in group C (P < 0.001). The SAS and SDS scores on POD 1 and POD 2 in groups L and E were significantly lower than in group C (P < 0.05). There were statistically significant differences in Numerical Rating Scale (NRS) scores among the three groups at 1 h, 2 h, 6 h and 12 h (P < 0.05). Conclusion: Perioperative IV lidocaine and esketamine improve the quality of postoperative recovery and the emotional state of patients undergoing thyroidectomy. [ABSTRACT FROM AUTHOR]

Introduction To evaluate the recovery quality between remimazolam and propofol after general anesthesia surgery. Methods We included eligible randomized controlled trials (RCTs) in EMBASE, PubMed, Cochrane Central, Scopus, and Web of Science up to June 26, 2024 for comparison the recovery quality of remimazolam and propofol after general anaesthesia. The primary outcomes were the total Quality of Recovery-15 (QoR-15) and five dimensions of QoR-15 on postoperative day 1 (POD1). Secondary outcomes were adverse events, the Quality of Recovery-40 (QoR-40) on POD1, and the intraoperative and postoperative time characteristics. Results Thirteen RCTs with a total of 1,305 patients were included in this meta-analysis. Our statistical analysis showed that remimazolam group had higher QoR-15 score on POD1, with no significant difference (Mean Difference (MD) = 1.24; 95% confidence interval (CI), [−1.67–4.15]; I2 = 75%; P = 0.41). In the five dimensions of QoR-15, remimazolam group was superior to propofol group in terms of physical independence (MD = 0.79; 95% CI [0.31–1.27]; I2 = 0%; P = 0.001). Remimazolam group was lower than propofol group in incidence of hypotension (Risk Ratio (RR) = 0.48; 95% CI [0.40–0.59]; I2 = 14%; P

Background: Multimodal analgesia plays a key role in enhanced recovery after surgery. Herein, we describe a trial protocol investigating the effects of oxycodone-vs. sufentanil-based patient-controlled analgesia in combination with quadratus lumborum block (QLB) vs. transverse abdominis plane block (TAPB) on quality of recovery following major laparoscopic gastrointestinal surgery. Methods: and analysis: This is a prospective, randomized, controlled clinical trial with a 2 × 2 factorial design. A total of 120 adult patients undergoing laparoscopic major gastrointestinal surgery will be randomized, in a 1:1:1:1 ratio, to receive one of two patient-controlled analgesia regimens (based on oxycodone or sufentanil) and one of two regional blocks (QLB or TAPB). The primary outcome measure of this trial is the quality of recovery at 24 h after surgery, assessed using the 15-item quality of recovery (QoR-15) scale. The secondary outcomes include QoR-15 scores at 48 and 72 h after surgery; visceral and incisional pain at rest and while coughing at 1, 6, 24 and 48 h postoperatively; analgesic consumption within 0–24 h and 24–48 h postoperatively; need for rescue analgesia; postoperative flatus time; postoperative adverse events (sedation, nausea and vomiting, use of antiemetics, respiratory depression, and dizziness); and length of postoperative hospital stay. Discussion: The results of this trial will provide evidence for the optimal multimodal analgesic strategy to improve the quality of recovery for patients undergoing laparoscopic major gastrointestinal surgery. Trial registration: This trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, identifier: ChiCTR2400080766).

Hai Xu,1 Conghui Hao,1 Xinxin Wang,2 Jingjing Du,1 Tianyu Zhang,1 Xiaobao Zhang2,3 1Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of ChinaCorrespondence: Xiaobao Zhang, Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China, Email hotdog100@163.comBackground: Magnesium sulfate, an intravenous adjuvant, has recently attracted immense attention in multimodal analgesia. Previous studies confirmed the crucial role of magnesium sulfate in postoperative pain and nociceptive hypersensitivity. However, the effect of magnesium sulfate in multimodal analgesia on the quality of recovery (QoR) for elderly patients has not been thoroughly studied. Therefore, the present experiment aimed to investigate the effect of continuous intravenous magnesium sulfate on the quality of postoperative recovery in elderly patients undergoing total knee arthroplasty (TKA).Patients and Methods: In this study, a total of 148 patients scheduled to undergo unilateral total knee arthroplasty were randomized into a magnesium sulfate group (Group M, n=68) and a control group (Group C, n=66) using a double-blind, randomized controlled trial. Before induction of anesthesia, Group M received intravenous magnesium sulfate (40 mg/kg) for 15 min, followed by a continuous infusion (15 mg/kg) until the end of the procedure. In the same manner, Group C received an infusion of the same amount of isotonic saline using the same method as the Group M.Results: Compared with Group C, Group M had significantly better QoR-15 scores on postoperative day 1(POD1) than Group C (P < 0.05). Analysis of the dimensions of QoR-15 scores indicated that Group M exhibited notably reduced levels of pain, and higher levels of emotional state and physical comfort than Group C (P < 0.05). Furthermore, Group C had significantly higher numerical rating scale (NRS) scores at POD1 than Group M (P < 0.05).Conclusion: For elderly patients undergoing knee arthroplasty, magnesium sulfate can be used as an adjuvant in a multimodal analgesic regimen to reduce early postoperative pain and improve the quality of early postoperative recovery.Keywords: magnesium sulfate, quality of recovery, postoperative pain, multimodal analgesic regimen, total knee arthroplasty

Abstract Background The purpose of the present study was to systematically delve into the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery after general anesthesia. Methods Randomized controlled trials related to TEAS improving postoperative recovery quality were searched in Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, Wanfang and Chinese biomedical database from the inception of each database to June 2023. After literature screening and data extraction, Stata15 software was employed for meta-analysis, and the quality of the included literature was evaluated utilizing ROB2. Results The study included 10 articles involving 2,383 patients in total. The meta-analysis results unveiled that TEAS could improve 24-hour and 48-hour postoperative QoR-40 scores as well as 24-hour postoperative QoR-40 dimension scores [WMD = 8.52, 95%CI (5.12, 11.91), P

Kai Zhao,1,2 Yali Gao,1,2 Jianping Zhang,1,2 Shan Wang,1,2 Jiaqi Chen,1,2 Fenglin Guo,1,2,&ast; Sheng Wang1,2,&ast; 1Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China; 2Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fenglin Guo; Sheng Wang, Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China, Tel +86 15395006763 ; +86 19156007726, Email 1030651261@qq.com; iamsheng2020@ustc.edu.cnPurpose: We designed this study to investigate the effect of intravenous use of penehyclidine on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery.Patients and Methods: Ninety-two Women Patients (Aged ≥ 18) Scheduled for Elective Gynecologic Laparoscopy Were Enrolled in the Current Study. Patients Were Equally Randomized Assigned Into Penehyclidine group (PHC group: received a bolus of penehyclidine 10 μg/kg during the induction of anesthesia, then followed by a continuous infusion of 10 μg/kg penehyclidine at a fixed rate of 2.0 mL/h in postoperative intravenous analgesia pump over 48h, 0.5 mg upper limit respectively) or Control group (received 0.9% saline in replace of penehyclidine at the same time points). The primary outcome measure was the incidence of postoperative nausea and vomiting in the postanesthesia care unit and ward area. Quality of Recovery-15 (QoR-15) scores and general comfort questionnaire (GCQ) scores were assessed on postoperative day (POD) 1, 2.Results: Patients between two groups had comparable baseline characteristics. Compared with the Control group, the incidence and severity of PONV, postoperative nausea (PON), and postoperative vomiting (POV) were significantly lower in the PHC group at 2h (PONV: P = 0.002, P = 0.004, respectively; PON: P = 0.018, P = 0.038, respectively; POV: P = 0.011, P = 0.072, respectively), 24h (PONV: P = 0.003, P = 0.001, respectively; PON: P = 0.010, P = 0.032, respectively; POV: P = 0.006, P = 0.044, respectively), and 48h (PONV: P = 0.003, P = 0.002, respectively; PON: P = 0.007, P = 0.019, respectively; POV: P = 0.002, P = 0.013, respectively) after surgery. The QoR-15 and GCQ scores of the PHC group were significantly higher than those of the Control group at POD 1, 2 (P < 0.001; P < 0.001, respectively).Conclusion: Our findings suggest that perioperative intravenous application of penehyclidine can effectively prevent postoperative nausea and vomiting in gynecological laparoscopic surgery patients and improve postoperative recovery.Keywords: penehyclidine, gynecologic laparoscopy, postoperative nausea and vomiting, quality of recovery

Background and Aims: Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. Methods: A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Results: Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). Conclusion: USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.

Jiwon Lee,1 Dong Woo Han,1 Na Young Kim,2 Keun-Su Kim,3 Yunil Yang,1 Juyeon Yang,4 Hye Sun Lee,4 Myoung Hwa Kim1 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea; 2Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 4Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Myoung Hwa Kim, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea, Fax +82-2-3463-0940, Email KMH2050@yuhs.acPurpose: Remimazolam is a newly developed ultra-short-acting benzodiazepine. We compared overall functional recovery, including the postoperative Quality of Recovery-15 (QoR-15) questionnaire scores, between balanced inhalational anesthesia using sevoflurane and total intravenous anesthesia (TIVA) with remimazolam in patients undergoing anterior cervical discectomy and fusion (ACDF).Patients and Methods: Seventy-two patients were randomized to the remimazolam (group R) or sevoflurane (group S) group. The primary outcome was the total QoR-15 score on postoperative day (POD) 1. We also assessed the total QoR-15 score on POD2, sub-scores of the QoR-15, perioperative parameters, and postoperative recovery profiles. Group-time interaction effects on the QoR-15 and its sub-scores were analyzed using a linear mixed model.Results: The total QoR-15 score on POD1 (120.2 in group R vs 114.3 in group S, P=0.189) was not statistically different between the groups. There were no significant group-time interaction effects on total QoR-15 scores. Instead, patients in group R showed significantly better sub-scores in psychological and postoperative nausea and vomiting (PONV) items on POD1, as well as a lower degree of PONV, than those in group S. Among the five dimensions of the QoR-15, a significant group-time interaction effect was observed for psychological support. Group R showed significantly less changeability in blood pressure and heart rate with a lower dose of intraoperatively administered vasopressor than group S.Conclusion: Considering QoR-15, including PONV reduction, and intraoperative hemodynamic stability, remimazolam can be used as the novel and safe anesthetic agent for maintaining general anesthesia instead of sevoflurane in patients undergoing ACDF.Plain Language Summary: Compared with balanced anesthesia using sevoflurane, total intravenous anesthesia with remimazolam showed better aspects for psychological support and postoperative nausea/vomiting in the quality of recovery and hemodynamic stability.Despite comparable total Quality of Recovery-15 scores, remimazolam-based total intravenous anesthesia could be a secure and suitable choice for patients undergoing cervical spine surgery.Keywords: cervical spine surgery, quality of recovery, remimazolam, sevoflurane, total intravenous anesthesia

Background: The purpose of the present study was to systematically delve into the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery after general anesthesia. Methods: Randomized controlled trials related to TEAS improving postoperative recovery quality were searched in Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, Wanfang and Chinese biomedical database from the inception of each database to June 2023. After literature screening and data extraction, Stata15 software was employed for meta-analysis, and the quality of the included literature was evaluated utilizing ROB2. Results: The study included 10 articles involving 2,383 patients in total. The meta-analysis results unveiled that TEAS could improve 24-hour and 48-hour postoperative QoR-40 scores as well as 24-hour postoperative QoR-40 dimension scores [WMD = 8.52, 95%CI (5.12, 11.91), P < 0.001; WMD = 1.99, 95%CI (0.91, 3.07), P < 0.001], emotional state [WMD = 1.38, 95%CI (0.66, 2.09), P < 0.001], physical comfort [WMD = 2.99, 95%CI (1.59, 4.39), P < 0.001], psychological support [WMD = 0.63, 95%CI (0.36, 0.90), P < 0.001], and physical independence [WMD = 0.76, 95%CI (0.22, 1.30), P = 0.006]; pain [WMD = 1.81, 95%CI (0.87, 2.75), P < 0.001]; decrease 24-hour postoperative VAS pain scores [WMD = -0.84, 95%CI (-1.45, -0.23), P = 0.007] and the incidence of postoperative nausea and vomiting [RR = 0.88, 95%CI (0.81, 0.97), P = 0.006; RR = 0.62, 95%CI (0.52, 0.73), P < 0.001]. Conclusion: TEAS can improve postoperative QoR-40 scores and the quality of recovery, relieve pain, and decrease the incidence of nausea and vomiting after surgery in patients who underwent general anesthesia. Trial registration: CRD42023433959. [ABSTRACT FROM AUTHOR]

Background and Aims: Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. Methods: A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Results: Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). Conclusion: USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated improvements in motor, behavioral, and emotional areas following transcranial direct current stimulation (tDCS), but no published studies have reported the efficacy of tDCS on postoperative recovery quality in patients undergoing lower limb major arthroplasty. We hypothesized that tDCS might improve postoperative recovery quality in elderly patients undergoing lower limb major arthroplasty. Methods: Ninety-six patients (≥65years) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to receive 2mA tDCS for 20min activetDCS or sham-tDCS. The primary outcome was the 15-item quality of recovery (QoR-15) score on postoperative day one (T2). Secondary outcomes included the QoR-15 scores at the 2nd hour (T1), the 1st month (T3), and the 3rd month (T4) postoperatively, numeric rating scale scores, and fatigue severity scale scores. Results: Ninety-six elderly patients (mean age, 71 years; 68.7% woman) were analyzed. Higher QoR-15 scores were found in the active-tDCS group at T2 (123.0 [114.3, 127.0] vs. 109.0 [99.3, 115.3]; median difference, 13.0; 95% CI, 8.0 to 17.0; p < 0.001). QoR-15 scores in the active-tDCS group were higher at T1 (p < 0.001), T3 (p = 0.001), and T4 (p = 0.001). The pain scores in the active-tDCS group were lower (p < 0.001 at motion; p < 0.001 at rest). The fatigue degree scores were lower in the active-tDCS group at T1 and T2 (p < 0.001 for each). Conclusion: tDCS may help improve the quality of early recovery in elderly patients undergoing lower limb major arthroplasty. Clinical trial registration: The trial was registered at the China Clinical Trial Center ChiCTR2200057777, https://www.chictr.org.cn/showproj.html?proj=162744). [ABSTRACT FROM AUTHOR]

No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85–0.92) and 0.73 (0.64–0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of transversus abdominis plane (TAP) block on postoperative recovery 24 h after cesarean delivery under general anesthesia. Methods: A propensity‐score‐matched, retrospective cohort study was used. A total of 173 pregnancies resulting in elective cesarean delivery under general anesthesia between March 2021 and March 2022 were analyzed retrospectively. Patients receiving TAP block were compared with those receiving only intravenous analgesia. The Quality of Recovery 15 (QoR‐15) score, assessed 24 h postoperatively using a 15‐item questionnaire, was the primary outcome. Secondary outcomes included time to first ambulation, time to first flatus postoperatively, ability to tolerate ambulation, visual analog scale (VAS) score, hospitalization cost, and postoperative nausea and/or vomiting. Results: The total QoR‐15 score 24 h postoperatively in the TAP group was significantly higher than in the Control group (P < 0.001). Patients in the TAP group had higher Bruggemann comfort scale scores (P < 0.001), could better tolerate early postoperative ambulation (P < 0.001), and had shorter time to first ambulation (P < 0.001) and flatus (P < 0.001). Correlation analysis demonstrated an inverse relationship between the cumulative VAS pain scores, time to first postoperative ambulation, time to first flatus, and total QoR‐15 score 24 h postoperatively. Conclusions: Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to postoperative ambulation and recovery of intestinal function. Synopsis: Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to recovery of intestinal function. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effect of the education provided to patients who would undergo mastectomy on psychological well-being and quality of recovery. The study had a randomized controlled trial design. The study was completed with 62 patients (30 in the experimental group and 32 in the control group). The experimental group received education the day before the operation, and the applications were made 3 days after the operation. A questionnaire form, the psychological well-being scale, and the quality of recovery questionnaire-40 (QoR-40) were used to collect the study data. The mean total score of the final measurement of the psychological well-being scale was higher in the experimental group than in the control group, and the difference was statistically significant. The difference between the final measurement total score average of QoR-40 and the final measurement point average of the subdimensions of the patients in the experimental and control groups was measured. The difference was statistically significant and the mean score of the experimental group was higher. Education can increase the level of psychological well-being and quality of recovery in patients who undergo mastectomy. Physiological and psychological education can be used as a tool in nursing practice to improve the level of psychological well-being and quality of recovery in postoperative patients. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) is a common complication, that can reduce patient satisfaction and may lead to serious consequences, such as wound dehiscence. Many strategies have been proposed to prevent PONV; however, it remains common, especially in highrisk surgeries such as gynecological surgery. In recent years, opioid-free anesthesia has been widely studied because it minimizes adverse reactions of opioids, such as nausea, vomiting, and itching; however, conclusions have been inconsistent. Therefore, we conducted this meta-analysis to investigate the effects of opioid-free anesthesia on PONV in patients undergoing gynecological surgery. Methods: A systematic search of the PubMed, Web of Science, Cochrane Library, and Embase databases, from inception to 28 August 2023, was performed. Keywords and other free terms were used with Boolean operators (OR and, AND) to combine searches. This review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Six studies involving 514 patients who underwent gynecological surgery were included. The forest plot revealed that the incidence of PONV (risk ratio = 0.52; p < 0.00001) and consumption of postoperative antiemetics use (risk ratio = 0.64; p = 0.03) were significantly lower in the opioid-free anesthesia group. In addition, opioid-free anesthesia improved the quality of recovery (mean difference = 4.69; p < 0.0001). However, there were no significant differences in postoperative pain scores (mean difference = 0.05; p = 0.85), analgesic use (risk ratio = 1.09; p = 0.65), and the time of extubation (mean difference = -0.89; p = 0.09) between the opioid-free anesthesia and control groups. Conclusion: OFA reduces PONV and the use of antiemetic drugs. In addition, it improves the quality of postoperative recovery. However, OFA can not reduce the postoperative pain scores, analgesic use and the time of extubation. Due to the strength of the evidence, we cannot support OFA as an ideal anesthesia method in gynecological surgery, and the implementation of anesthesia strategies should be case-by-case. [ABSTRACT FROM AUTHOR]

Purpose: Major spinal surgery causes severe postoperative pain. The present randomized, controlled, prospective study tested the short- and long-term effects of thoracolumbar interfascial and erector spinae plane blocks on patient-centered outcomes for major lumbar spinal surgery. Methods: Sixty adult patients were randomly assigned to receive either bilateral thoracolumbar interfascial plane or erector spinae plane block after anesthesia induction using bupivacaine 0.25%, 20 mL. The primary outcome of this study was the Quality of Recovery-40 score in the postoperative 24th hour. Secondary outcomes were Comprehensive Complication Index scores, postoperative pain scores, opioid consumption, first rescue analgesic administration time, and complication incidence. Results: The recovery scores of both blocks at the postoperative 24th hour were similar, with a median thoracolumbar interfascial plane block of 178 (IQR 173–180) and an erector spinae plane block of 175 (IQR 168.7–182) (p = 0.717). Thoracolumbar interfascial plane block reduced area under the curve pain with movement over 24 h compared with erector spinae plane block (p = 0.024). The pain scores between the groups were similar at all time points (p > 0.05), except the 24th hour with movement in the thoracolumbar interfascial plane block compared with the erector spinae plane block [median 3 (IQR 2–4)] vs. 4 (IQR 3–5), respectively] (p = 0.019). No differences were recorded between the block groups regarding postoperative 24th-h oxycodone consumption, time to first opioid intake, and complication incidence (p > 0.05). Conclusions: Both blocks resulted in similar quality of recovery in the postoperative 24-h period in major spinal surgery and were effective in terms of analgesia. [ABSTRACT FROM AUTHOR]