Intraoperative Total Intravenous Anaesthesia is associated with reduced postoperative opioid consumption after colorectal surgery

Abstract

Aim of Investigations: Clinical studies have shown that total intravenous anesthesia (TIVA) with propofol results in better postoperative pain control compared with inhalational anaesthesia, while other studies show no significant differences[1-6]. The analgesic effect of TIVA with propofol in colorectal surgery has not been evaluated. The aim of this study is to evaluate the postoperative analgesic effects of TIVA with propofol versus inhalational sevoflurane in colorectal surgery. Methods: A retrospective case controlled study was performed. Records of patients undergoing colorectal surgery from 2014-2016 (36 months) were retrieved. Ninety-five patients who received TIVA with propofol were matched with 95 patients who received sevoflurane for general anaesthesia. Outcomes that were compared were acute postoperative numerical pain scores (NRS), postoperative morphine consumption, patient satisfaction, and side effects. NRS pain scores was evaluated using unpaired t-test with Welch's correction and PCA morphine consumption was assessed using Mann-Whitney test. Fisher's Exact test was used to evaluate for differences in postoperative side effects and patient satisfaction. Results: Patients receiving TIVA with propofol had significantly reduced total morphine consumption (p˂ 0.001), and daily morphine consumption on postoperative days 1 (p=0.031), 2 (p=0.002) and 3 (p=0.031) compared with those receiving sevoflurane. However, there were no significant differences in NRS pain scores, incidence of side effects, and patient satisfaction between the two groups. Conclusions: TIVA with propofol had opioid sparing effects compared with sevofurane for patients undergoing colorectal surgery. Adequately sample sized randomized controlled trials are indicated to confirm the benefits in colorectal surgery. References : 1. Peng, K., et al., Does Propofol Anesthesia Lead to Less Postoperative Pain Compared With Inhalational Anesthesia?: A Systematic Review and Meta-analysis. Anesth Analg, 2016. 123(4): p. 846-58. 2. Chan, A.C., et al., Effects of Intra-Operative Total Intravenous Anaesthesia with Propofol versus Inhalational Anaesthesia with Sevoflurane on Post-Operative Pain in Liver Surgery: A Retrospective Case-Control Study. PLoS One, 2016. 11(2): p. e0149753. 3. Qiu, Q, et al., Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis. Anaesthesia, 2016. 71(10): p. 1222-33. 4. Cheng, S.S., J. Yeh, and P. Flood, Anesthesia matters: patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg, 2008. 106(1): p. 264-9, table of contents. 5. Fassoulaki, A., et al., Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol. Anesth Analg, 2008. 107(5): p. 1715-9. 6. Pokkinen, S.M., A. Yli-Hankala, and M.L. Kalliomaki, The effects of propofol vs. sevoflurane on post-operative pain and need of opioid. Acta Anaesthesiol Scand, 2014. 58(8): p. 980-5.