Comparison between target-controlled infusion propofol and target-controlled inhalational anesthesia sevoflurane in mastectomy surgery in Indonesia

Abstract

Background: Health-care system reform in Indonesia is challenging for anesthesiologists in determining the minimum cost of anesthesia and maintaining inflammation and pain to a minimum. This study is aimed to analyze the effectiveness of general anesthesia techniques between target-controlled inhalational anesthesia (TCIA) sevoflurane and target-controlled infusion (TCI) propofol in mastectomy surgery from the perspective of cost, C-reactive protein (CRP) levels, postoperative pain level, postoperative opioid consumption, and side effects. Patients and Methods: This was a randomized controlled trial with permuted block randomization of 60 subjects allocated into TCIA sevoflurane (Group S) and TCI propofol (Group P). In Group S, we used sevoflurane 8 vol% for induction and maintained with sevoflurane 1-1.5 vol%, compressed air, and oxygen. In Group P, we used TCI propofol with target effect 4 mcg/mL and maintained with TCI propofol (target effect of 1-3 mcg/ml), compressed air, and oxygen. Results: The cost in Group S was US$ 36.33 compared to US$ 29.69 in Group P (P = 0.002). The CRP level was comparable between the two groups (38.39 [42.13] vs. 23.88 [45.26]. P = 0.487). There is neither difference in pain score, total morphine consumption, and side effects between both groups in the first 24-h postoperative period, nor morphine consumption in 24 h postoperative. Conclusion: The cost of anesthesia-related expense in TCI propofol is lower than TCIA sevoflurane in mastectomy surgery underwent general anesthesia. There is no significant difference in terms of CRP levels, postoperative pain, postoperative morphine consumption, and incidence of side effects.