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

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 patient-controlled 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 (375 mu g vs 485 mu g, P=.032, 414 mu g vs 572 mu g, P=.033, and 421 mu g vs 479 mu g, P=.209, respectively), less cumulative fentanyl consumption at postoperative 48hours (790 mu g vs 1057 mu g, P=.004) and 72hours (1210 mu g vs 1536 mu g, P=.004), and total fentanyl consumption (1393 mu g vs 1704 mu g, 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.