Fast-Track Eligibility and Hospital Discharge for Outpatient Lumbar Discectomy

Gulhane School of Medicine

Status: Completed

Conditions: Post-Op Complication; Lumbar Disc Disease

Treatments: Other: SPEEDS criteria; Other: White's Fast-Track Scoring System (WFTSS); Other: Modified Aldrete Scoring System (mASS)

Study type: Observational

Funder types: Other

Identifiers

NCT04301232

18/148

Details and patient eligibility

About

122 ASA I-II patients were enrolled into the study. IV propofol, fentanyl and rocuronium were used for the induction and a total intravenous anesthesia technique for the maintenance of anesthesia. Sugammadex was given for neuromuscular blockade reversal. A multi-modal analgesic regimen was utilized. Primary outcome measures were PACU bypass rates and hospital discharge times. Secondary outcome measure was to compare discharge scoring systems for PACU bypass assessment: modified Aldrete Scoring System (mASS), White's Fast-Tracking Scoring System (WFTSS), and SPEEDS criteria

Full description

After obtaining hospital's ethics committee approval (University of Medical Sciences, Gülhane Training and Research Hospital- Date: 06/05/2018; No: 18/148) and written informed consents obtained from patients, 122 ASA (American Society of Anesthesiologists) physical status I-II patients, aged between 18-65 years, undergoing elective lumbar discectomy under general anesthesia were included into the study . After anesthesia application applied to all groups with the same procedure, patients were extubated after surgery. After extubation, patients were evaluated using mASS, WFTSS and SPEEDS criteria during 15 minutes with 3 min intervals. Patients who fulfilled criteria of all scoring systems were defined as eligible for PACU by-pass (fast-tracking) and transferred into phase II recovery area in the ward without observation in PACU (Group FT = Fast Track;). Ineligible patients were taken into PACU where their treatments were continued until discharge criteria were achieved (Group PACU). All patients were followed in the ward until hospital discharge. IV tramadol PCA (Patient -Controlled Analgesia; infusion rate: 4 mgh-1, bolus dose: 4mg, lock-out time: 30 min., 4 hours-limit: 30 mg), paracetamol (10 mgkg-1 IV with 6 hrs. intervals) and oral diclofenac sodium (75 mg with 8 hrs. intervals) were given in a multimodal analgesic regimen. Pain was evaluated using Visual Analogue Scale (VAS) with 2 hours intervals and IV pethidine 0.5 mgkg-1 was given as rescue analgesic throughout the study period when VAS was >3. PONV was treated using IV 4 mg ondansetron. Discharge from hospital was evaluated using Post Anesthetic Discharge Scoring System (PADSS), . Patients with a PADSS score ≥ 9 were discharged from the hospital by the escort of their relatives.

Enrollment: 122 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA (American Society of Anesthesiologists) physical status I-II patients
• elective primary lumbar discectomy performed for one or two vertebra levels under general anesthesia
• minimal risks for perioperative bleeding and airway safety

Exclusion criteria

• patient's refusal
• urgent surgery,
• regional anesthesia,
• history of previous lumbar surgery
• difficult ventilation and intubation,
• treatment for chronic pain
• obstructive sleep apnea,
• morbid obesity (BMI≥40 kg/m2)
• allergy to drugs

Trial design

122 participants in 2 patient groups

Fast-Track Group

Description:

After extubation, patients were evaluated using modified Aldrete Scoring System (mASS) , White's Fast- Track Scoring System (WFTSS) and SPEEDS criteria during 15 minutes with 3 min intervals. Patients who fulfilled criteria of all scoring systems were defined as eligible for PACU by-pass (fast-tracking) and transferred into phase II recovery area in the ward without observation in PACU (Group FT = Fast Track;)

Treatment:

Other: White's Fast-Track Scoring System (WFTSS)

Other: SPEEDS criteria

Other: Modified Aldrete Scoring System (mASS)

PACU Group

Description:

After extubation, patients were evaluated using modified Aldrete Scoring System (mASS) , White's Fast- Track Scoring System (WFTSS) and SPEEDS criteria during 15 minutes with 3 min intervals. Ineligible patients were taken into PACU where their treatments were continued until discharge criteria were achieved (Group PACU)

Treatment:

Other: White's Fast-Track Scoring System (WFTSS)

Other: SPEEDS criteria

Other: Modified Aldrete Scoring System (mASS)