- New clinical trial VITAL led by University of Warwick and UK Perioperative Medicine Clinical Trials Network will compare inhalation and intravenous anaesthesia methods to determine how soon patients return home after surgery
- Both methods are routinely used in the NHS, but research on their impact on recovery is limited
- 2,500 patients to be recruited across 40 hospitals from May 2021
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.”
Notes to editors:
UK Perioperative Medicine Clinical Trials Network (POMCTN)
The UK Perioperative Medicine Clinical Trials Network (POMCTN) aims to create an environment which allows everyone with an interest in perioperative care to make a meaningful but realistic contribution to clinical trials and observational studies. The aim is to promote engagement with clinical trials and early implementation of the findings. (https://pomctn.org.uk/)
Perioperative Quality Improvement Programme (PQIP)
PQIP was established in 2016 by the National Institute of Academic Anaesthesia’s (NIAA) Health Services Research Centre, working on behalf of the Royal College of Anaesthetists (RCoA); it is a research study sponsored by University College London. PQIP evaluates the perioperative care of patients undergoing major non-cardiac surgery aiming to improve patient outcomes, reduce variation in processes of care and support implementation of best practice. It has recruited more than 30,000 patients to date. (https://pqip.org.uk/)
About the NIHR
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
● Funds, supports and delivers high quality research that benefits the NHS, public health and social care
● Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
● Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
● Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
25 November 2020