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cepts to improve sleep postoperatively 1 ; it was only recently that Krenk et al. suggested that prophylactic intervention to improve sleep architecture be included in fast-track methodology. 3 The impact of surgery and anesthesia on postoperative sleep after hysterectomy in a fast-track setting has not been carefully Study Objectives: To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. Methods: A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire. Results: Women in the general anesthesia group experienced bad quality of sleep the night after surgery signifi cantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a signifi cantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the fi rst night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the fi rst night postoperatively (p = 0.002). Conclusions:The quality of sleep the fi rst night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs. S C I E N T I F I C I N v E S T I G A T I O N ST he purpose of fast-track programs in surgery is to enhance postoperative recovery. 1 Fast-track programs usually involve modalities to optimize preoperative conditions, including the provision of detailed information about the cause of events peri-and postoperatively. In the operative period, the use of regional anesthesia and minimally invasive surgery are advocated. Multimodal pain control, antiemetic prophylaxis, early mobilization, and enteral nutrition are encouraged. Fast-track programs almost unanimously recommend use of opioid-free or opioid-reduced multimodal analgesia postoperatively. 1One of the most prevalent postoperative symptoms following hysterectomy is disturbed sleep.2 Postoperative sleep disturbances may affect mood, re...

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