Comparison of the Quality of Recovery Using QoR-40 Questionnaire between Total Intravenous Anesthesia and Balanced Anesthesia in Patients Undergoing Elective Supratentorial Craniotomy, A Randomized Controlled Trial

BACKGROUND: The quality of recovery following neurosurgery is of utmost significance, and the type of anesthesia used directly impacts it. Previous research on total intravenous anesthesia (TIVA) and inhalation anesthesia yielded mixed results. We used the Quality of Recovery-40 questionnaire (QoR-40) to prove equivalence in quality of recovery between TIVA and balanced anesthesia in patients undergoing elective supratentorial tumor resection. METHODS: After Institutional Review Board approval, this prospective, single-blinded, single-center, randomized equivalence trial was conducted at a tertiary care hospital in southern India. 93 adults undergoing elective supratentorial craniotomy were randomly allocated into Group A (n = 48) and Group B (n = 45). Group A received TIVA with propofol, while Group B received balanced anesthesia with Sevoflurane. The primary outcome was a QoR-40 score on postoperative days 1, 2, and 3. Secondary endpoints were intraoperative hemodynamics, brain relaxation score, recovery profile, and postoperative analgesia. RESULTS: The global QoR-40 score, measured on the preoperative day, POD1, and POD2 were comparable between Group A (TIVA) and Group B (Sevoflurane Balanced). The POD3 QoR-40 was lower (P = 0.015 95% CL; 18.9-0.8) for Group A (111.8 ± 8.9) versus Group B (116.6 ± 9.7). However, the mean difference in the score between TIVA and the balanced group on the POD1, POD2, and POD3 (-1.8, -2.8, -4.8) was lesser than the minimal clinically significant difference of 6.3. No significant difference was found in secondary outcomes. CONCLUSIONS: TIVA and balanced anesthesia provide comparable quality of recovery as assessed with the QoR-40 score in adults undergoing elective supratentorial craniotomy and tumor excision.