A Prospective Randomized Comparison of Postoperative Pain and Complications after Thyroidectomy under Different Anesthetic Techniques: Volatile Anesthesia versus Total Intravenous Anesthesia

Abstract

While the postoperative outcome is favorable, post-thyroidectomy pain is considerable. Reducing the postoperative acute pain, therefore, is considered important. This study investigated whether the pain intensity and need for rescue analgesics during the immediate postoperative period after thyroidectomy differ according to the methods of anesthesia. Seventy-two patients undergoing total thyroidectomy under general anesthesia were examined. Patients were randomly assigned to undergo either total intravenous anesthesia with remifentanil and propofol (TIVA, n = 35) or propofol induction and maintenance with desflurane and nitrous oxide (volatile anesthesia [VA], n = 37). The mean administered dose of remifentanil was 1977.7 ± 722.5 μg in the TIVA group, which was approximately 0.268 ± 0.118 μg/min/kg during surgery. Pain scores based on a numeric rating scale (NRS) and the need for rescue analgesics were compared between groups at the postoperative anesthetic care unit (PACU). The immediate postoperative NRS values of the TIVA and VA groups were 5.7 ± 1.7 and 4.7 ± 2.3, respectively ( P = 0.034). Postoperative morphine equianalgesic doses in the PACU were higher in the TIVA group than in the VA group (16.7 ± 3.8 mg vs. 14.1 ± 5.9 mg, P = 0.027). The incidence of immediate postanesthetic complications did not differ significantly between groups. In conclusion, more rescue analgesics were required in the TIVA group than in the VA group to adequately manage postoperative pain while staying in the PACU after thyroidectomy.

Recovery Benefit With Total Intravenous Anesthesia in Patients Receiving Rhinoplasty

“…Similarly, morphine doses in the recovery room were significantly increased in this subset compared to the inhaled anesthesia group. 21 In comparison, our study did not find a significant difference in pain medications (narcotics, nonnarcotics, or either) or oral MME doses administered to either cohort in the PACU.…”

Total Intravenous Anesthesia Versus Inhaled Sevoflurane in Obstructive Sleep Apnea Surgery: A Randomized Controlled Trial

“…A postoperative pain numerical rating scale showed a significantly higher mean score for TIVA patients (5.7) versus inhalational patients (4.7). Further, their TIVA patients required higher morphine equivalent doses in the PACU (16.7 vs. 14.1 mg) 21 . In a double‐blind randomized study of middle ear surgery patients, Mukherjee et al assessed 100 individuals receiving either TIVA with propofol‐remifentanil or a balanced anesthesia approach with fentanyl, propofol, and isoflurane.…”

“…Further, their TIVA patients required higher morphine equivalent doses in the PACU (16.7 vs. 14.1 mg). 21 In a double-blind randomized study of middle ear surgery patients, Mukherjee et al assessed 100 individuals receiving either TIVA with propofol-remifentanil or a balanced anesthesia approach with fentanyl, propofol, and isoflurane. In the PACU, TIVA patients had elevated pain scores, and required significantly more morphine.…”

Total intravenous anesthesia versus inhalation anesthesia: how do outcomes compare?

“…Interestingly, in thyroid surgery, propofol-based TIVA has been associated with higher intensity of postoperative pain as well as higher postoperative opioid consumption [29 ▪ ]. Furthermore, other clinical studies have found no beneficial analgesic effects of propofol-based TIVA in hysterectomy and colon surgery [29 ▪ ,30].…”