effect of epidural anesthesia and analgesia on quality of recovery after unilateral nephrectomy.

Conditions: Anesthesia; Anesthesia Recovery Period; Nephrectomy; Patient Satisfaction; Postoperative Period; Quality of Life; Analgesia; Epidural

Summary: different modality of anesthesia and analgesia could influence a postoperative quality of recovery (qor). this study is exploring early qor after unilateral nephrectomy in the two groups of anesthesia. the first group had a light general anesthesia with thoracic epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. the second group had general anesthesia and a continuous postoperative analgesia with tramadol. the postoperative qor was evaluated 24 hours after surgery.

all participants were premedicated with diazepam 5 mg 12 hours and 1 hour before surgery. thromboprophylaxis ( 4,000 - 6000 iu) depending on the body weight was given at least 12 hours before surgery. all participants were warmed to prevent unintended hypothermia. participants were allocated by permuted-block randomisation into one of two groups: general anesthesia group and epidural anesthesia. the randomisation list was obtained from r program version 3.5.3. the group allocations were contained in a closed envelope that were opened before surgery after the completed enrollment procedure. all patients and infusions were wormed to prevent unintended hypothermia. induction of general anesthesia was with midazolam 2.5 mg, fentanyl 100 μg, propofol 1-2 mg/kg and vecuronium 0.1 mg/kg. balanced crystalloid fluids were used to treat hypovolemia. additionally, 6% hydroxyethyl starch was used before blood transfusion products to treat profound hypovolemia. blood transfusions were given according to clinical situation. bradycardia was treated with atropine. hypotension was treated with ephedrine boluses. anti-inflammatory drug metamizole (dipyrone) 2.5 g was given intravenously before the end of the surgery and after 12 hours after the surgery. neostigmine 2.5 mg with atropine 1 mg was used for the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery. participants were placed for one day in a urology high care unit provided with constant and vigilant nurse care. crystalloid infusions were used for maintaining diuresis. gastroprotection was done with pantoprazole 40 mg. metoclopramid 10 mg was given for postoperative nausea and vomiting (ponv). the postoperative qor was evaluated with three qor scales. scales for pain, anxiety and ponv were also examined. the 36-item short form survey (sf-36) questionnaire evaluated quality of life one month before and one month after surgery.

Eligibility criteria:
inclusion criteria: * elective radical nephrectomy * american society of anesthesiologists (asa) physical status classification system: i, ii, iii exclusion criteria: * dementia * delirium * acute psychosis * emergent surgery * hospitalisation in intensive care unit * american society of anesthesiologists (asa) physical status classification system: iv * reoperations * muscular diseases * montreal cognitive test \<24 points * contraindications for epidural anesthesia

Keywords: general anesthesia combined light general and epidural anesthesia health related quality of life nephrectomy