Br.J. Anaesth. (1979), 51, 785
MORBIDITY IN GYNAECOLOGICAL DAY-CASE SURGERY A comparison of two anaesthetic techniques T. M. HUNT, O. M. PLANTEVIN AND J. R. GILBERT SUMMARY
Day-case surgery is practised increasingly both for economic reasons and for the convenience of the patient. However, Fahy and Marshall (1969) have reported a high frequency of morbidity after surgery, extending often into the 2nd day after operation, and a recent study of patients undergoing minor gynaecological surgery as day cases demonstrated that abdominal pain was a common complaint following surgery (Towey et al., 1979). The present study was designed to investigate whether the inclusion of a powerful short-acting analgesic in the anaesthetic technique could reduce the frequency of this complaint. Two simple anaesthetic techniques were compared; one technique included the analgesic fentanyl, while the other used halothane as the main agent. METHODS
One hundred and three patients undergoing dilatation and curettage of the uterus in the outpatient theatre at St Thomas's Hospital were studied. Patients were assessed before operation by the anaesthetist and those not considered suitable for day-case surgery for medical or social reasons, and those receiving tranquillizer or anti-depressant drugs were excluded. No premedication was given and surgery took place in the morning. The same medical and nursing staff were involved throughout the study. Patients were allocated randomly to one of two groups: in group H anaesthesia was induced with 1% methohexitone 60-100 mg and maintained with 60% nitrous oxide in oxygen with halothane 1% as necessary. In group F T. M. HUNT, M.B., B.S., M.R.C.P., F.F.A.R.C.S. ; O. M. PLANTEVIN, M.B., CH.B., F.F.A.RX.S. ; J. R. GILBERT, S.R.N.,
s.c.M.; Department of Anaesthetics, St Thomas' Hospital, London SE.l. 0007-0912/79/080785-03 $01.00
a single dose of fentanyl calculated on a weight basis was given i.v. immediately before induction. Patients weighing between 50 and 70 kg received 100 \xg; those weighing less than 50 kg received 75 jxg and those weighing more than 70 kg, 125 [ig. Anaesthesia was induced with 1 % methohexitone 60-100 mg and maintained with 60% nitrous oxide in oxygen and incremental doses of methohexitone (to a total of 100 mg). The time of induction and the time of completion of the procedure were recorded, as was the occurrence of minor complications such as hiccup or cough. No major complications were observed. Each patient recovered from the anaesthetic on a trolley and the time at which she opened her eyes in response to her name was recorded. The occurrence of nausea, vomiting, abdominal pain and other symptoms was noted and two tablets of Distalgesic (dextropropoxyphene 65 mg and paracetamol 650 mg) was prescribed for the relief of pain if necessary. Antiemetics were not given unless repeated vomiting occurred. The patients were usually fit to go home with an escort about 3 h after the operation and just before leaving the hospital each patient was asked to complete a questionnaire recording the presence or absence of each of the following sequelae: abdominal pain, backache, headache, nausea, vomiting, drowsiness, dizziness and muscle ache. In addition the patient was given three further questionnaires to be completed on the 3rd evening after operation and returned to the hospital by post. These sought the occurrence of the same symptoms during the following periods: the remainder of the day and evening of operation, the first day after operation and the second day after operation. Chi-square test was used to evaluate the significance of differences between the groups. © Macmillan Journals Ltd 1979
Downloaded from http://bja.oxfordjournals.org/ at McMaster University Library on July 28, 2015
The effectiveness of fentanyl, given as part of the anaesthetic technique, in reducing abdominal pain following outpatient gynaecological surgery has been examined. It was found to reduce significantly the frequency of abdominal pain in the period extending from discharge from hospital to the first evening, while not compromising surgical conditions nor increasing the frequency of other postoperative sequelae such as nausea and vomiting.
BRITISH JOURNAL OF ANAESTHESIA
786
TABLE I. Frequency (number and per cent) of symptoms and complications at the four times of enquiry. H = halothane group; F = fentanyl group. | = not significant; *P
MORBIDITY IN GYNAECOLOGICAL DAY-CASE SURGERY A comparison of two anaesthetic techniques T. M. HUNT, O. M. PLANTEVIN AND J. R. GILBERT SUMMARY
Day-case surgery is practised increasingly both for economic reasons and for the convenience of the patient. However, Fahy and Marshall (1969) have reported a high frequency of morbidity after surgery, extending often into the 2nd day after operation, and a recent study of patients undergoing minor gynaecological surgery as day cases demonstrated that abdominal pain was a common complaint following surgery (Towey et al., 1979). The present study was designed to investigate whether the inclusion of a powerful short-acting analgesic in the anaesthetic technique could reduce the frequency of this complaint. Two simple anaesthetic techniques were compared; one technique included the analgesic fentanyl, while the other used halothane as the main agent. METHODS
One hundred and three patients undergoing dilatation and curettage of the uterus in the outpatient theatre at St Thomas's Hospital were studied. Patients were assessed before operation by the anaesthetist and those not considered suitable for day-case surgery for medical or social reasons, and those receiving tranquillizer or anti-depressant drugs were excluded. No premedication was given and surgery took place in the morning. The same medical and nursing staff were involved throughout the study. Patients were allocated randomly to one of two groups: in group H anaesthesia was induced with 1% methohexitone 60-100 mg and maintained with 60% nitrous oxide in oxygen with halothane 1% as necessary. In group F T. M. HUNT, M.B., B.S., M.R.C.P., F.F.A.R.C.S. ; O. M. PLANTEVIN, M.B., CH.B., F.F.A.RX.S. ; J. R. GILBERT, S.R.N.,
s.c.M.; Department of Anaesthetics, St Thomas' Hospital, London SE.l. 0007-0912/79/080785-03 $01.00
a single dose of fentanyl calculated on a weight basis was given i.v. immediately before induction. Patients weighing between 50 and 70 kg received 100 \xg; those weighing less than 50 kg received 75 jxg and those weighing more than 70 kg, 125 [ig. Anaesthesia was induced with 1 % methohexitone 60-100 mg and maintained with 60% nitrous oxide in oxygen and incremental doses of methohexitone (to a total of 100 mg). The time of induction and the time of completion of the procedure were recorded, as was the occurrence of minor complications such as hiccup or cough. No major complications were observed. Each patient recovered from the anaesthetic on a trolley and the time at which she opened her eyes in response to her name was recorded. The occurrence of nausea, vomiting, abdominal pain and other symptoms was noted and two tablets of Distalgesic (dextropropoxyphene 65 mg and paracetamol 650 mg) was prescribed for the relief of pain if necessary. Antiemetics were not given unless repeated vomiting occurred. The patients were usually fit to go home with an escort about 3 h after the operation and just before leaving the hospital each patient was asked to complete a questionnaire recording the presence or absence of each of the following sequelae: abdominal pain, backache, headache, nausea, vomiting, drowsiness, dizziness and muscle ache. In addition the patient was given three further questionnaires to be completed on the 3rd evening after operation and returned to the hospital by post. These sought the occurrence of the same symptoms during the following periods: the remainder of the day and evening of operation, the first day after operation and the second day after operation. Chi-square test was used to evaluate the significance of differences between the groups. © Macmillan Journals Ltd 1979
Downloaded from http://bja.oxfordjournals.org/ at McMaster University Library on July 28, 2015
The effectiveness of fentanyl, given as part of the anaesthetic technique, in reducing abdominal pain following outpatient gynaecological surgery has been examined. It was found to reduce significantly the frequency of abdominal pain in the period extending from discharge from hospital to the first evening, while not compromising surgical conditions nor increasing the frequency of other postoperative sequelae such as nausea and vomiting.
BRITISH JOURNAL OF ANAESTHESIA
786
TABLE I. Frequency (number and per cent) of symptoms and complications at the four times of enquiry. H = halothane group; F = fentanyl group. | = not significant; *P
