Total intravenous anaesthesia versus inhalational anaesthesia and influence on acute postoperative pain after thoracic surgery

Introduction As the influence of total intravenous anaesthesia (TIVA) on acute postoperative pain has been predominantly studied in general surgeries, there is only limited data on thoracic procedures. Moreover, the selection of TIVA versus inhalational anaesthesia (VA) in thoracic procedures has been debated due to its effect on one lung ventilation (OLV) and the overall role remains unclear. Therefore, the objective of this study was to review postoperative pain intensity and analgesic consumption in post anaesthetic care unit (PACU) on postoperative day 0 (POD 0), postoperative day 1 and 2 (POD 1, 2) following thoracic surgical intervention (1, 2). Methods Following institutional approval, a retrospective observational study with prospective data collection was performed in a single tertiary cardiothoracic centre. Primary outcomes were postoperative numerical rating scale pain scores (NRS) at rest and movement in PACU and POD 1, 2, intraoperative analgesic requirements and postoperative morphine equianalgesic doses between TIVA and VA groups. Results A total of 70 patients were identified for the study, 11 were excluded due to incomplete data. Therefore, total patients included were n=59; TIVA (n = 31) and VA (n = 28). Both groups had similar characteristics in terms of age, gender, and ASA group. All patients received paravertebral block infusion and opioid based patient-controlled analgesia (PCA) postoperatively. Intraoperatively there was significantly higher usage of Clonidine 69 mcg vs 36 mcg (p = 0.005), and Ketamine 36 mg vs 23 mg (p < 0.001) in TIVA vs VA group respectively. The immediate postoperative NRS values (PACU) of the TIVA and VA groups were 5.3 ± 3.4 and 3.6 ± 3, respectively (p = 0.07), with no significant difference in between groups on POD 1, 2 (Figure 1). There was no difference in NRS on movement on any of the studied days (p = 0.543). Postoperative morphine consumption was similar in TIVA and VA group at PACU (POD 0) and on POD 1, 2 (p = 0.581) (Figure 2). Discussion Adequate postoperative analgesia remains challenging in thoracic procedures. TIVA did not improve postoperative analgesia or reduced postoperative opioid consumption significantly. Further larger study is required to establish benefit of these anaesthetic modalities in term of acute pain management.