Quality of Recovery after Open Gynecological Surgery.

Area of Science:

• Anesthesiology
• Surgical Recovery
• Pain Management

Background:

• Hysterectomies are common major open gynecological surgeries requiring effective postoperative pain management.
• Regional anesthesia techniques, including spinal anesthesia and Rectus Sheath Block (RSB), are explored for multimodal analgesia to reduce opioid consumption and enhance recovery.
• Open gynecological surgery leads to significant postoperative pain and requires adequate analgesia strategies.

Purpose of the Study:

• To compare the effects of standard general endotracheal anesthesia, spinal anesthesia, and Ultrasound (US)-guided bilateral Rectus Sheath Block (RSB) on the quality of recovery after open gynecological surgery.
• To evaluate the impact of different anesthetic techniques on postoperative pain, opioid consumption, and patient satisfaction.

Main Methods:

• A prospective randomized study involving 51 female patients undergoing elective open gynecological surgery.
• Patients were divided into three groups: control (general anesthesia), spinal anesthesia (intrathecal bupivacaine and fentanyl), and RSB (bilateral US-guided ropivacaine before general anesthesia).
• The Quality of Recovery questionnaire (QoR-15) was used to assess the primary outcome, with secondary outcomes including opioid consumption, time to first flatus, time to discharge from bed, PONV, analgesic consumption, and patient satisfaction.

Main Results:

• The Rectus Sheath Block (RSB) group showed reduced intraoperative opioid consumption, faster recovery milestones (flatus, discharge from bed), lower postoperative analgesic needs, and shorter PACU discharge time.
• The spinal anesthesia group experienced less initial postoperative pain, earlier recovery milestones, and a lower incidence of postoperative nausea and vomiting (PONV).
• Patient satisfaction was highest in the RSB group, moderate in the spinal anesthesia group, and average in the control group.

Conclusions:

• Regional anesthesia techniques, specifically Rectus Sheath Block (RSB) and spinal anesthesia, are recommended for open gynecological surgery.
• Both RSB and spinal anesthesia significantly improve the quality of recovery, reduce postoperative pain and opioid consumption, and enhance patient satisfaction compared to standard general anesthesia.
• Ultrasound-guided RSB and spinal anesthesia offer effective alternatives for managing pain and improving recovery outcomes in patients undergoing major gynecological procedures.