Quality of recovery after open gynecological surgery

Introduction: Hysterectomies are one of the most common major open gynecologic surgeries. Open
gynecological surgery results in a large wound and severe postoperative pain, and adequate postoperative
analgesia is necessary. As part of multimodal analgesia strategies, regional anesthesia techniques are widely
used in such surgeries to reduce opioid consumption and enhance analgesic efficacy. Spinal anesthesia, as
a regional anesthesia technique, and Rectus Sheath Block (RSB) can provide adequate anesthesia and are
explored in this prospective randomized study.
Objective: The aim of this study was to evaluate and compare the effect of standard general endotracheal
anesthesia, regional block-spinal anesthesia, and bilateral Ultrasound (US)-guided RSB on the quality of
recovery after open gynecological surgery.
Patients and Methods: This prospective randomized study was carried out on 51 females, ASA I or II
presented for elective gynecological surgery randomly classified into 3 equal groups (each of 17 patients):
Group C (n=17) is control group where the patients received standard general endotracheal anesthesia;
patients in Group S (n=17) - received regional- spinal block with applied intrathecal 20 mg (4.0 ml) of
0.5 % hyperbaric bupivacaine and 20 μg fentanyl; patients in Group R (n=17)- received Rectus sheath
block with 40 ml ropivacaine 0.375% (20ml each side) before the surgery and standard endotracheal an-
esthesia. The primary outcome, the quality of recovery, was assessed by the 15-item Quality of Recovery
questionnaire (QoR-15). Secondary outcomes included intraoperative opioid consumption, time to first
flatus, time to first discharge from bed, postoperative nausea and vomiting (PONV), postoperative analgesic
consumption and patient satisfaction.
Results and conclusion: Postoperative global QoR-15 scores in the patient group R were in the range
of 101.94-117.30 (103-119), and those among the in-patient Group S were in the range of 98.71-107.58
(102-109). The patients from Group R, with applied preoperative RSB, had reduced intraoperative opioid
consumption, moderate time to first flatus and time to first discharge from bed, low postoperative analgesic
consumption, and shorter post-anesthesia care unit discharge time (p<0.05). Patients from Group S, with
applied spinal anesthesia, had less or absent initial postoperative pain, abbreviated time to first flatus and
time to first discharge from bed, a lower incidence of postoperative nausea and vomiting (PONV), and an
early ability to ambulate. Regarding patient satisfaction, for patient group C was average, group S displayed
moderate patient satisfaction and group R had high patient satisfaction. According to the obtained results,
the use of regional techniques (RSB or spinal anesthesia) are recommended for open gynecological surgery.