Comparison of Total Intravenous Anaesthesia (TIVA)versus Inhalational Anaesthesia during elective spine surgery –A randomized controlled study

Sevoflurane,an  inhalational anesthetic agent  offer advantages such as stable intraoperative hemodynamic course and rapid emergence from anesthesia. .It has have very low blood/gas partition coefficient (0.7), which offers rapid induction and emergence from anesthesia. Hence, it was deemed  suitable for spine surgeries.

Intravenous anesthetic propofol, according to its pharmacokinetic profile, is the mainstay for total intravenous anesthesia (TIVA); it has rapid onset and offset with fewer side effects, particularly postoperative nausea and vomiting (PONV).  Propofol has long been considered a nonanalgesic intravenous hypnotic. In human volunteers, propofol at a hypnotic dose of 3.5 mcg/ml decreased pain-related regional blood flow to the thalamus and anterior cingulate cortex.   It was found to  significantly decrease pain scores by 40% and areas of hyperalgesia and allodynia in human volunteers.Propofol’s preferential binding to the HCN1 pacemaker channels further reinforces its anti-hyperalgesic effect. Moreover, the anti-inflammatory effects of propofol have been shown both in vitro[9] and in human studies[and they may be responsible for propofol role in postoperative analgesia. Propofol-based anesthesia has been shown to be associated with reduced postoperative pain compared with volatile anesthesia, whereas other studies have reported no evidence of the superiority of propofol.A recent meta-analysis comparing postoperative pain between inhalational and propofol anesthesia showed no significant differences (P value of .04) probably due to substantial heterogeneity among studies.

The aim of this prospective study is to evaluate the recovery parameters of propofol-fentanyl based TIVA compared to inhalational anesthesia in  spine surgery.