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

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Feb 23

PMID 26901037

Citations 10

Authors

Alfred Chor San Chan

Qiu Qiu

Siu Wai Choi

Stanley Sau Ching Wong

Albert Chi Yan Chan

Michael G Irwin

Chi Wai Cheung

Affiliations

Soon will be listed here.

Abstract

Background: Patients receiving total intravenous anesthesia (TIVA) with propofol have been shown to experience less postoperative pain. We evaluated the post-operative analgesic effects of propofol compared with sevoflurane maintenance of anesthesia in liver surgery. This study was registered at ClinicalTrials.gov (NCT02179437).

Methods: In this retrospective study, records of patients who underwent liver surgery between 2010 and 2013 were reviewed. Ninety-five patients anesthetized with propofol TIVA were matched with 95 patients anesthetized with sevoflurane. Numeric pain rating scale (NRS) pain scores, postoperative morphine consumption, side effects and patients' satisfaction with pain relief were evaluated.

Results: The TIVA group reported lower NRS pain scores during coughing on postoperative days 1 and 2 but not 3 (p = 0.0127, p = 0.0472, p = 0.4556 respectively). They also consumed significantly less daily (p = 0.001 on day 1, p = 0.0231 on day 2, p = 0.0004 on day 3), accumulative (p = 0.001 on day 1, p<0.0001 on day 2 and p = 0.0064 on day 3) and total morphine (p = 0.03) when compared with the sevoflurane group. There were no differences in total duration of intravenous patient controlled analgesia (PCA) morphine use and patient satisfaction. No difference was found in reported side effects.

Conclusion: Patients anesthetized with propofol TIVA reported less pain during coughing and consumed less daily, accumulative and total morphine after liver surgery.

Citing Articles

Update on Resection Strategies for Hepatocellular Carcinoma: A Narrative Review.

Lee J, Choi H, Kim J, Lee T, Yoon Y Cancers (Basel). 2024; 16(23).

PMID: 39682279 PMC: 11640626. DOI: 10.3390/cancers16234093.

The analgesic effect of total intravenous anaesthesia with propofol versus inhalational anaesthesia for acute postoperative pain after hepatectomy: a randomized controlled trial.

Wong S, Wang F, Chan T, Cheung C BMC Anesthesiol. 2023; 23(1):112.

PMID: 37013472 PMC: 10069060. DOI: 10.1186/s12871-023-02063-7.

Total intravenous anesthesia for liver resections: anesthetic implications and safety.

Tan S, Hwang N Korean J Anesthesiol. 2022; 75(5):363-370.

PMID: 36167475 PMC: 9539420. DOI: 10.4097/kja.22517.

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.

Wong S, Choi E, Chan W, Cheung C BMC Anesthesiol. 2022; 22(1):140.

PMID: 35538421 PMC: 9088064. DOI: 10.1186/s12871-022-01683-9.

Propofol Alleviates Neuropathic Pain Induced by Chronic Contractile Injury by Regulating the Spinal glun2b-p38mapkepac1 Pathway.

Li W, Qin C, Yan J, Zhao Q, You L, Yang Y Comput Math Methods Med. 2021; 2021:9305076.

PMID: 34804196 PMC: 8601802. DOI: 10.1155/2021/9305076.

References

Suttner S, Boldt J, Schmidt C, Piper S, Kumle B . Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimens. Anesth Analg. 1999; 88(1):77-82. DOI: 10.1097/00000539-199901000-00015. View

Nadeson R, Goodchild C . Antinociceptive properties of propofol: involvement of spinal cord gamma-aminobutyric acid(A) receptors. J Pharmacol Exp Ther. 1997; 282(3):1181-6. View

Breivik H, Borchgrevink P, Allen S, Rosseland L, Romundstad L, Hals E . Assessment of pain. Br J Anaesth. 2008; 101(1):17-24. DOI: 10.1093/bja/aen103. View

Feltracco P, Carollo C, Barbieri S, Milevoj M, Pettenuzzo T, Gringeri E . Pain control after liver transplantation surgery. Transplant Proc. 2014; 46(7):2300-7. DOI: 10.1016/j.transproceed.2014.07.023. View

Ko J, Choi S, Gwak M, Kim G, Ahn H, Kim J . Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors. Liver Transpl. 2009; 15(4):381-9. DOI: 10.1002/lt.21625. View

Samir A, Gandreti N, Madhere M, Khan A, Brown M, Loomba V . Anti-inflammatory effects of propofol during cardiopulmonary bypass: a pilot study. Ann Card Anaesth. 2015; 18(4):495-501. PMC: 4881689. DOI: 10.4103/0971-9784.166451. View

Guindon J, Loverme J, Piomelli D, Beaulieu P . The antinociceptive effects of local injections of propofol in rats are mediated in part by cannabinoid CB1 and CB2 receptors. Anesth Analg. 2007; 104(6):1563-9, table of contents. DOI: 10.1213/01.ane.0000263278.05423.a3. View

Kumar G, Stendall C, Mistry R, Gurusamy K, Walker D . A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Anaesthesia. 2014; 69(10):1138-50. DOI: 10.1111/anae.12713. View

Antognini J, Wang X, Piercy M, Carstens E . Propofol directly depresses lumbar dorsal horn neuronal responses to noxious stimulation in goats. Can J Anaesth. 2000; 47(3):273-9. DOI: 10.1007/BF03018926. View

10.

Cheung C, Ying C, Lee L, Tsang S, Tsui S, Irwin M . An audit of postoperative intravenous patient-controlled analgesia with morphine: evolution over the last decade. Eur J Pain. 2008; 13(5):464-71. DOI: 10.1016/j.ejpain.2008.05.013. View

11.

Cheng S, Yeh J, Flood P . Anesthesia matters: patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg. 2008; 106(1):264-9, table of contents. DOI: 10.1213/01.ane.0000287653.77372.d9. View

12.

Taura P, Fuster J, Blasi A, Martinez-Ocon J, Anglada T, Beltran J . Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally. Anesth Analg. 2003; 96(2):475-80, table of contents. DOI: 10.1097/00000539-200302000-00033. View

13.

Honda M, Yamamoto K, Furukawa T . Retrospective propensity score matching and the selection of surgical procedures: how precise can a propensity estimate be?. J Clin Oncol. 2014; 32(28):3200-1. DOI: 10.1200/JCO.2014.55.9682. View

14.

Smith I, White P, Nathanson M, Gouldson R . Propofol. An update on its clinical use. Anesthesiology. 1994; 81(4):1005-43. View

15.

Fassoulaki A, Melemeni A, Paraskeva A, Siafaka I, Sarantopoulos C . Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol. Anesth Analg. 2008; 107(5):1715-9. DOI: 10.1213/ane.0b013e318182d84e. View

16.

Lyashchenko A, Redd K, Yang J, Tibbs G . Propofol inhibits HCN1 pacemaker channels by selective association with the closed states of the membrane embedded channel core. J Physiol. 2007; 583(Pt 1):37-56. PMC: 2277223. DOI: 10.1113/jphysiol.2007.136465. View

17.

Rudin A, Lundberg J, Hammarlund-Udenaes M, Flisberg P, Werner M . Morphine metabolism after major liver surgery. Anesth Analg. 2007; 104(6):1409-14, table of contents. DOI: 10.1213/01.ane.0000261847.26044.1d. View

18.

Chandok N, Watt K . Pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc. 2010; 85(5):451-8. PMC: 2861975. DOI: 10.4065/mcp.2009.0534. View

19.

Kingston S, Mao L, Yang L, Arora A, Fibuch E, Wang J . Propofol inhibits phosphorylation of N-methyl-D-aspartate receptor NR1 subunits in neurons. Anesthesiology. 2006; 104(4):763-9. DOI: 10.1097/00000542-200604000-00021. View

20.

Tan T, Bhinder R, Carey M, Briggs L . Day-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane. Anesth Analg. 2009; 111(1):83-5. DOI: 10.1213/ANE.0b013e3181c0ee9e. View