A new clinical trial will compare two types of anaesthetic to determine how soon after surgery they allow patients to return home.
The Volatile vs Total intravenous Anaesthesia for major non-cardiac surgery (VITAL) trial is led by Warwick Clinical Trials Unit at the University of Warwick and will compare two methods of delivering anaesthesia to a patient: inhalation and intravenous. Launched this week at the Anaesthesia Research 2020 meeting, it is funded the National Institute for Health Research and was developed by the UK Perioperative Medicine Clinical Trials Network.
Their results could help determine which method is more effective at helping patients return home after surgery without complications.
More than 1.5 million patients require general anaesthesia for major surgery each year in the NHS. Inhalational anaesthesia is most commonly used, and involves the patient breathing anaesthetic gas through a breathing tube whilst asleep.
Some patients receive an alternative called total intravenous anaesthesia, or ‘TIVA’. During a TIVA anaesthetic, the patient breathes oxygen through a breathing tube and the anaesthetic is given via injection into a vein.
Previous research and some anecdotal evidence from anaesthetic doctors has suggested that patients recover more quickly after TIVA, and that patients prefer this technique. However, research so far has been limited and small scale. Both techniques are currently in routine use and the choice of which to use is made by the clinician (anaesthetist) in charge of patient care. All anaesthetists are trained in both techniques.
The VITAL trial aims to recruit 2,500 patients undergoing major non-cardiac surgery in 40 NHS hospitals. Each patient will be randomised to receive either TIVA or inhalational anaesthesia during their surgery, and the researchers will record how much time they have spent at home in the 30 days following their operation. Participants will also be asked about their experience and satisfaction of their type of anaesthetic, while the research team will also conduct a cost effectiveness analysis.
The VITAL trial will be partnering with the Perioperative Quality Improvement Programme (PQIP), a national study run by the Health Services Research Centre at the Royal College Anaesthetists, to use the same data collection procedures and improve the efficiency of the trial.
Chief Investigator Dr Joyce Yeung of Warwick Medical School said: “Improving outcomes after surgery is a public health research priority for patients, clinicians and the NHS. The lack of robust evidence comparing these two routinely used general anaesthetic techniques means that neither can be recommended as standard.
“Prompt recovery and discharge from hospital will enhance physical recovery, limiting immobility and physical deconditioning. These aspects are of growing importance as older patients now undergo major surgery more often than ever before. Our findings will help clinicians choose the technique for optimal patient recovery.
“Participants will undergo surgery with general anaesthesia as planned just like other patients. There are no additional delays or risks to participants. As with all clinical trials, participants will be closely monitored and followed up for 6 months post-surgery.”