Anaesthesia maintenance with propofol versus sevoflurane to reduce postoperative pain: Still too early for recommendations?

Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: a large-scale retrospective study with covariate adjustment

Background

To compare the postoperative analgesic effect of propofol total intravenous anaesthesia (TIVA) versus inhalational anaesthesia (GAS) in patients using morphine patient-controlled analgesia (PCA).

Methods

A retrospective cohort study was performed in a single tertiary university hospital. Adult patients who used PCA morphine after general anaesthesia across 15 types of surgeries were included. Patients who received propofol TIVA were compared to those who had inhalational anaesthesia. Primary outcomes assessed were postoperative numerical rating scale (NRS) pain scores and postoperative opioid consumption.

Results

Data from 4202 patients were analysed. The overall adjusted NRS pain scores were significantly lower in patients who received propofol TIVA at rest (GEE: β estimate of the mean on a 0 to 10 scale = -0.56, 95% CI = (-0.74 to -0.38), p < 0.001; GAS as reference group) and with movement (β estimate = -0.89, 95% CI = (-1.1 to -0.69), p < 0.001) from postoperative days (POD) 1–3. Propofol TIVA was associated with lower overall adjusted postoperative morphine consumption (β estimate = -3.45, 95% CI = (-4.46 to -2.44), p < 0.001). Patients with propofol TIVA had lower adjusted NRS pain scores with movement for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p < 0.001) and urological surgeries (p = 0.005); and less adjusted postoperative morphine consumption for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p = 0.006) and urological surgeries (p = 0.002). There were no differences for other types of surgeries.

Conclusion

Propofol TIVA was associated with statistically significant, but small reduction in pain scores and opioid consumption in patients using PCA morphine. Subgroup analysis suggests clinically meaningful analgesia possibly for hepatobiliary/pancreatic and upper gastrointestinal surgeries.

Trial registration

This study is registered at ClinicalTrials.gov (NCT03875872).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01683-9.

Propofol based total intravenous anesthesia versus sevoflurane based inhalation anesthesia: The postoperative characteristics in oral and maxillofacial surgery

OBJECTIVE

Total intravenous anesthesia and inhalation/volatile anesthesia are the main general anesthesia procedures used in all surgical applications. The aim of this study was to compare sevoflurane anesthesia and total intravenous anesthesia with propofol in terms of postoperative complications, especially after oral and maxillofacial surgeries.

MATERIAL AND METHODS

Each patient was taken to the recovery room following extubation, and the pulse rate, non-invasive blood pressure (NIBP) and oxygen saturation were monitored. Presence of hypoxia, tachycardia, bradycardia, hypertension and hypotension were determined as vital sign complications.

RESULTS

The risk of complications related to vital functions were low for both anesthesia methods, and no statistically significant difference between the groups. The incidence of nausea and vomiting was found to be significantly higher in the patients undergoing both major (p = 0.011) and minor (p = 0.021) surgeries in the IA-S group. The recovery time was found to be significantly longer in the TIVA-P group compared to the IA-S group in the patients undergoing both major (p = 0.026) and minor surgery (p = 0.018).

CONCLUSION

TIVA and IA methods, which are considered safe in terms of vital signs, should be preferred according to patient characteristics. Despite the fact that inhaled anesthetics require PONV premedication for long term interventions, we believe that they could be preferred due to shorter recovery time compared to intravenous anesthetics.