Effect of adding phenylephrine infusion to goal-directed fluid therapy on postoperative quality of recovery in elderly patients undergoing laparoscopic gastrointestinal surgery: a randomized controlled trial.

BACKGROUND: Goal-directed fluid therapy (GDFT) guided by pulse pressure variation (PPV) is an established strategy to optimize perioperative fluid management in elderly surgical patients. However, its efficacy may be limited by age-related decline in vascular compliance. This study aimed to investigate whether supplementing PPV-guided GDFT with a continuous low-dose phenylephrine infusion could improve the quality of postoperative recovery in this population. METHODS: Ninety-four elderly patients scheduled for elective laparoscopic gastrointestinal surgery were randomized to either PPV-guided GDFT with phenylephrine (GP group, N.=46) or GDFT alone (G group, N.=48). Following anesthesia induction, the GP group received a continuous phenylephrine infusion (0.2~0.25 μg/kg/min), while the G group received normal saline at an equivalent rate. Both groups used a PPV threshold of ≥13% to guide fluid administration. The primary outcome was the 24-hour postoperative QoR-15 score. Secondary outcomes included QoR-15 scores at 48 hours and seven days, intraoperative variables, recovery markers, and laboratory results. RESULTS: Baseline characteristics showed no statistical differences between G group and GP group (P>0.05).GP group demonstrated notably higher 24-h (103.46±4.17 vs. 93.10±2.90) and 48-h (117.00±3.43 vs. 108.08±3.04) QoR-15 total scores, along with superior performance in multiple subitems (P<0.001). Additionally, GP group received less intraoperative fluid (1825 [1550.0-2250.0] vs. 2250 [1862.5-2500.0] mL, P=0.002) and exhibited shorter time to first flatus (38.3±6.0 vs. 59.0±12.5 h) and hospital stay (14.2±2.7 vs. 17.0±4.4 d), with all these differences statistically significant (P<0.001). No disparities were observed in renal parameters, lactate levels, or postoperative complications (P>0.05). CONCLUSIONS: For elderly laparoscopic gastrointestinal surgery patients, PPV-guided GDFT combined with phenylephrine improved early recovery, accelerated gastrointestinal function, shortened hospital stay, without added circulatory or renal risks.