Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: Comparison with desflurane anesthesia - A randomised trial

Abstract

Background: As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery. Methods: Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/ fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patientcontrolled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded. Results: The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P=.002, P=.133, P=.161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375mg vs 485mg, P=.032, 414mg vs 572mg, P=.033, and 421mg vs 479mg, P=.209, respectively), less cumulative fentanyl consumption at postoperative 48hours (790mg vs 1057mg, P=.004) and 72hours (1210mg vs 1536mg, P=.004), and total fentanyl consumption (1393mg vs 1704mg, P=.007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects. Conclusion: Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery. Abbreviations: APS = acute pain service, BIS = bispectral index, DES = desflurane anesthesia, NRS = numeric pain rating scale, PCA = patient control analgesia, PONV = postoperative nausea and vomiting, TCI = target-controlled infusion, TIVA = total intravenous anesthesia.