Inhalational versus intravenous maintenance of anesthesia for quality of recovery in patients undergoing corrective lower limb osteotomy: A randomized controlled trial

Abstract

Background Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA. Methods Sixty-eight patients, ASA class I or II who underwent corrective lower limb osteotomy were randomized to receive either desflurane anesthesia or propofol TIVA. The primary outcome was quality of recovery 40 (QoR-40) questionnaire scores on postoperative day (POD) 1 and 2. Postoperative nausea scores, antiemetic requirements, and amount of opioid consumption via intravenous patient-controlled analgesia (IV PCA) were assessed as secondary outcomes. Results Global QoR-40 scores on POD 1 (153.5 (140.3, 171.3) vs. 140.0 (120.0, 173.0), P = 0.056, 95% CI; -22.5, 0.2) and POD 2 (155.5 (146.8, 175.5) vs. 152.0 (134.0, 179.0), P = 0.209, 95% CI; -17.5, 3.9) were comparable between the two groups. Among the five dimensions of QoR-40, physical independence scores were significantly higher in the TIVA group compared to the Desflurane group on POD both 1 and 2. Nausea scores (0.0 (0.0, 0.0) vs. 1.0 (0.0, 3.5), P < 0.001) and number of patients requiring rescue antiemetics (0% vs. 15.2%, P = 0.017) were significantly lower in the TIVA group at the post anesthesia care unit (PACU). Although the number of bolus attempts between 0–24 h and the morphine equivalent dose of analgesics administered via IV PCA between 12–24 h were significantly less in the TIVA group compared to the Desflurane group, there was no significant difference between groups for the overall 48 h postoperative period. Conclusions Propofol-based TIVA did not improve global QoR-40 scores compared with desflurane-based inhalational anesthesia. However, considering the better QoR-40 scores in the domain of physical independence and less nausea in the early postoperative period, propofol TIVA should be considered as a useful option in patients undergoing corrective lower limb osteotomy.

Effects of Total Intravenous Versus Inhalational Anesthesia on Bleeding During Endoscopic Ear Surgery: Preliminary Results From a Case-Control Study

“…According to these properties of TIVA, several works were conducted to demonstrate that TIVA allowed better surgical visibility during ESS compared with IA, even if when stratifying results according to different intraoperative visibility scales and different inhaled anesthetic agents; these findings were not consistent (11,(18)(19)(20). On the other hand, more recent studies focusing on the quality of recovery in patients undergoing surgery comparing the TIVA versus IA, not only in the ear-nose-throat field, confirmed the best recovery in the TIVA groups (21)(22)(23)(24).…”

Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair

“…GA with IA is the gold standard anesthesia technique for a wide variety of surgical procedures and is typically safe and effective, although it is accepted that some percentage of patients will experience side effects such as nausea, vomiting, poorly controlled postoperative pain, and postoperative cognitive impairment [6,17]. Several studies from a variety of surgical specialties indicate that TIVA may improve the quality of recovery after surgery by mitigating some of the uncomfortable effects of IA [11,[17][18][19]. In contrast to a study by Kim et al, there was no difference in postoperative nausea scores, pain scores, and opioids given in this study when comparing IA and TIVA [11].…”

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

“…The QoR-40 score ranges from a minimum of 40 points (poor quality of recovery) to a maximum of 200 points (excellent quality of recovery) [31]. The impact of the type of anesthesia in QoR-40 score is usually evaluated during the earlier postoperative period (postoperative days 1 and 2) [32]. Low QoR-40 scores are associated with postoperative complications and increased length of stays in cardiac surgery.…”

“…For example, in pancreatic, thyroid, eye and sinus endoscopic surgery, propofol-based TIVA has been associated with improved QoR-40 score [36–39]. On the contrary, in laparoscopic cholecystectomy, corrective limb osteotomy, and otorhinolaryngological and gynecologic surgery, QoR-40 was not influenced by the type of the anesthesia technique [32,40–42]. The latest systematic review evaluating the impact of propofol-based TIVA and volatile anesthetics on postoperative quality of recovery involved nine randomized control trials with 922 patients.…”