Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: a large-scale retrospective study with covariate adjustment

Abstract

Background To compare the postoperative analgesic effect of propofol total intravenous anaesthesia (TIVA) versus inhalational anaesthesia (GAS) in patients using morphine patient-controlled analgesia (PCA). Methods A retrospective cohort study was performed in a single tertiary university hospital. Adult patients who used PCA morphine after general anaesthesia across 15 types of surgeries were included. Patients who received propofol TIVA were compared to those who had inhalational anaesthesia. Primary outcomes assessed were postoperative numerical rating scale (NRS) pain scores and postoperative opioid consumption. Results Data from 4202 patients were analysed. The overall adjusted NRS pain scores were significantly lower in patients who received propofol TIVA at rest (GEE: β estimate of the mean on a 0 to 10 scale = -0.56, 95% CI = (-0.74 to -0.38), p < 0.001; GAS as reference group) and with movement (β estimate = -0.89, 95% CI = (-1.1 to -0.69), p < 0.001) from postoperative days (POD) 1–3. Propofol TIVA was associated with lower overall adjusted postoperative morphine consumption (β estimate = -3.45, 95% CI = (-4.46 to -2.44), p < 0.001). Patients with propofol TIVA had lower adjusted NRS pain scores with movement for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p < 0.001) and urological surgeries (p = 0.005); and less adjusted postoperative morphine consumption for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p = 0.006) and urological surgeries (p = 0.002). There were no differences for other types of surgeries. Conclusion Propofol TIVA was associated with statistically significant, but small reduction in pain scores and opioid consumption in patients using PCA morphine. Subgroup analysis suggests clinically meaningful analgesia possibly for hepatobiliary/pancreatic and upper gastrointestinal surgeries. Trial registration This study is registered at ClinicalTrials.gov (NCT03875872).

Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors

“…The effect of different anesthetic techniques such as propofol-based total intravenous versus inhalational anesthesia seems to be very limited, although theoretically helpful through the antagonizing effect of propofol on the N-methyl-D-aspartate (NMDA) receptor and possibly preventive in certain study populations [6,103,132]. While certain effects seem to make sense in a pathophysiological way and single studies show some effects of pharmacological interventions, a currently updated meta-analysis shows the disappointing fact that overall, the effects of most drugs (e.g.…”

Total intravenous anesthesia for liver resections: anesthetic implications and safety

“…Some clinical studies have also suggested that propofol TIVA is associated with a reduction in postoperative pain [ 27 , 28 ]. A subgroup analysis in a recent retrospective cohort study found that propofol TIVA was associated with a clinically significant reduction in postoperative pain scores and opioid consumption in patients undergoing hepatobiliary and pancreatic surgery [ 29 ]. Another retrospective study found that propofol TIVA was associated with less pain during coughing and reduced morphine consumption in patients undergoing liver surgery [ 30 ].…”

Optimizing Nonopioid Analgesia and Different Pain Management Options following Abdominoplasty: A Systematic Literature Review

“…Five clinical trials did not show a significant difference. 13 The use of bilateral tranversus abdominis plane block for abdominoplasty was associated with a longer postoperative analgesia duration in the last 24 hours and lower morphine consumption in the first 24 hours than other surgically infiltrated anesthetic techniques. 14 Liposomal bupivacaine (Exparel) was introduced as a safe method and an alternative to invasive postoperative pain management options such as PCA, epidurals, peripheral nerve catheters, or intravenous narcotics.…”