Comparison of Postoperative Recovery Between TIVA and Inhalation Agent

Adult patients undergoing elective laparoscopic or robotic assisted nephrectomy are randomly allocated to receive propofol based total intravenous anesthesia (n=75) or desflurane (n=75). The quality of recover after surgery using the QoR-15K was assessed by a investigator at postoperative day (POD) 1, 2, and 3. The primary outcome is the QoR-15K at POD 1, 2, and 3 after surgery.

• total intravenous anesthesia with propofol (Drug), also known as TIVA group: In the TIVA group, general anesthesia is induced and maintained with a target-controlled infusion of propofol using infusion pump (Orchestra®; Fresenius Vial, Brezins, France). In both groups, remifentanil is continuously infused throughout the surgery for balanced anesthesia, adjusted to maintain arterial pressure.
• inhalation anesthesia with desflurane (Drug), also known as DES group: In the desflurane group, anesthesia is induced with propofol 1-2 mg/kg and maintained with desflurane (5-7 vol %). In both groups, remifentanil is continuously infused throughout the surgery for balanced anesthesia, adjusted to maintain arterial pressure.

Primary outcomes

• quality of recovery [at 24 hours, 48 hours, 72 hours postoperatively]: Change in the QoR-15K score from 24 hours to 72 hours postoperatively

Secondary outcomes

• Postoperative pain score [at 24 hours, 48 hours, 72 hours postoperatively]: Change in the pain severity measured by the 11-pointed numeric rating scale (0: none/10: worst pain) pain score at resting/movement from 24 hours to 72 hours postoperatively
• Postoperative nausea and vomiting during the first 24 hours postoperatively [during the first 24 hours postoperatively]: Incidence of postoperative nausea and vomiting (%)
• Postoperative nausea and vomiting during the 24-48 hours postoperatively [during the 24-48 hours postoperatively]: Incidence of postoperative nausea and vomiting (%)
• Postoperative nausea and vomiting during the 48-72 hours postoperatively [during the 48-72 hours postoperatively]: Incidence of postoperative nausea and vomiting (%)
• Total fentanyl consumption during the first 24 hours postoperatively [during the first 24 hours postoperatively]: Change in the postoperative fentanyl consumption (mcg) via IV patient controlled analgesia from 24 hours to 72 hours postoperatively
• Total fentanyl consumption during the 24-48 hours postoperatively [during the 24-48 hours postoperatively]: Change in the postoperative fentanyl consumption (mcg) via IV patient controlled analgesia from 24 hours to 72 hours postoperatively
• Total fentanyl consumption during the 48-72 hours postoperatively [during the 48-72 hours postoperatively]: Change in the postoperative fentanyl consumption (mcg) via IV patient controlled analgesia from 24 hours to 72 hours postoperatively
• Quality of life at early post-discharge [day before surgery and at 3 weeks after discharge]: Change in the Quality of life measured using the EuroQoL 5-dimension 5-level scale (EQ-5D-5L) from baseline to early-postdischarge phase

Sex: All, ages: 19 Years to 80 Years

Inclusion Criteria:

* Patients scheduled to undergo elective laparoscopic or robotic assisted nephrectomy under general anesthesia
* American Society of Anesthesiologists (ASA) physical classification I-II
* Willingness and ability to sign an informed consent document

Exclusion Criteria:

* Do not understand our study
* American Society of Anesthesiologists (ASA) physical classification III or more
* Allergies to anesthetic or analgesic medications
* Chronic pain, chronic analgesic or antidepressant or anticonvulsant use
* Medical or psychological disease that can affect the treatment response
* Patients who receive mechanical ventilation more than 2 hours after surgery

• Lee WK, Kim MS, Kang SW, Kim S, Lee JR. Type of anaesthesia and patient quality of recovery: a randomized trial comparing propofol-remifentanil total i.v. anaesthesia with desflurane anaesthesia. Br J Anaesth. 2015 Apr;114(4):663-8. doi: 10.1093/bja/aeu405. Epub 2014 Dec 10. PMID 25500679