Total Intravenous Anesthesia (TIVA) With Propofol for Acute Postoperative Pain: A Scoping Review of Randomized Controlled Trials

Abstract

Total intravenous anesthesia (TIVA) with propofol may improve acute postoperative pain control compared to inhalational anesthesia. The objective of this review was to comprehensively update and evaluate the existing literature on the analgesic efficacy of propofol TIVA. A systemiz literature search for randomized controlled trials in adult patients was conducted in the PubMed and Cochrane CENTRAL (EMBASE source) databases up to August 2019. Clinical trials included compared propofol TIVA against inhalational isoflurane, sevoflurane, or desflurane. Only clinical trials that studied acu postoperative pain scores or analgesic consumption as a primary outcome were included. Sixteen randomized controll trials were included. Surgical procedures evaluated included: radical gastrectomy, open vein strippin breast cancer surgery, laparoscopic cholecystectomy, inguinal herniotomy, abdominoplasty, bariatric surger lumbar spine surgery, emergency neurosurgical operations, open and laparoscopic gynecological surgeries, a dental surgery. Propofol TIVA was associated with reduced postoperative pain scores and/or decreased opioid consumption in 9 out of 16 clinical trials. There was no difference in 5 clinical trials, a propofol TIVA was associated with worse analgesic outcomes in 2 trials. Propofol TIVA may improve acu postoperative analgesia after surgery, but different factors such as surgical procedures and anesthetic/analges techniques may infl uence its effectiveness.