Effects of TIVA With Propofol Versus Inhalational Anaesthesia on Postoperative Pain After Hepatectomy
Status:
Unknown status
Trial end date:
2020-12-01
Target enrollment:
Participant gender:
Summary
Propofol is a commonly used intravenous anaesthetic drugs both for induction and maintenance
of general anaesthesia. Advantages of total intravenous anaesthesia (TIVA) with propofol
include reduced nausea and vomiting, reduced atmospheric pollution, and better wake up
profile. But the need for a reliable intravenous access, specialized pumps, pain on injection
and potential concerns regarding awareness are potential disadvantages of TIVA propofol.
Results from clinical trials have not been consistent. Some randomized trials have shown
improved analgesia with TIVA propofol, and some reported no significant difference. A
meta-analysis found that propofol was associated with a statistically significant reduction
pain scores 24 hours after surgery. However, the clinical effect size was small. Therefore,
the usefulness of propofol as an analgesic adjunct is still inconclusive.
Whether TIVA propofol is useful in providing significant postoperative analgesia may be
influenced by the type of surgery and accompanying analgesic regime. This agrees with the
concept of procedure specific analgesia. Liver surgery produces moderate to severe pain as a
result of an upper abdominal incision. Pain control can be difficult due to concerns with
epidural analgesia in patients with potential clotting abnormalities and the effect of
analgesic metabolism as a in patients with liver dysfunction. Results from our retrospective
study showed that TIVA propofol was associated with reduced pain scores with coughing on
postoperative days 1 and 2, and also reduced opioid consumption when compared with
sevoflurane after liver surgery.
In this study, the investigators plan to conduct a randomized controlled trial to further
determine whether TIVA propofol reduces acute postoperative pain and opioid consumption after
hepatectomy.