Effects of propofol anesthesia versus sevoflurane anesthesia on postoperative pain after radical gastrectomy: a randomized controlled trial
Authors Ji F, Wang D, Zhang J, Liu H, Peng K
Received 7 February 2018
Accepted for publication 9 April 2018
Published 25 June 2018 Volume 2018:11 Pages 1247—1254
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Dr Erica Wegrzyn
Fu-hai Ji,* Dan Wang,* Juan Zhang, Hua-yue Liu, Ke Peng
Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
*These authors contributed equally to this work
Purpose: After a radical gastrectomy, patients may experience severe pain. Some studies have reported that the use of propofol significantly reduced postoperative pain, while others have argued that this effect was not significant. Thus, we aimed to assess whether anesthesia with propofol could help to reduce pain after an open radical gastrectomy procedure.
Patients and methods: Sixty patients who were scheduled to undergo a laparotomy for radical gastrectomy were randomly assigned to either the propofol or sevoflurane group (n=30 each). A target-controlled infusion of propofol or inhalation of sevoflurane, titrated to bispectral index of 40–60, was maintained. All patients were administered a standardized multimodal analgesic plan, including intraoperative dexmedetomidine, dexamethasone, and postoperative flurbiprofen axetil, as well as patient-controlled fentanyl. Hemodynamics, pain scores, fentanyl consumption, adverse events, and the incidence of chronic pain 1 month and 3 months following hospital discharge were recorded.
Results: The intensity of postoperative pain was relatively low to moderate in all the patients. The propofol group showed lower pain scores, at rest and while coughing, up to 48 h postoperatively compared to the sevoflurane group (P<0.05). Cumulative fentanyl consumption 0–24 h after surgery was lower for the propofol group (364.4 ± 139.1 vs. 529.3 ± 237.9 µg; P=0.002). However, for fentanyl consumption 0–48 h, the difference between the two groups was not significant (710.9 ± 312.8 vs. 850.9 ± 292.0 µg; P=0.078). There were no differences in the incidences of adverse events or chronic pain between the groups.
Conclusions: Overall, the multimodal analgesic approach reduced postoperative pain after an open radical gastrectomy procedure in all patients anesthetized with either propofol or sevoflurane. Furthermore, our results indicated better analgesic outcome for the propofol group, especially in the early postoperative period.
Keywords: anesthesia, propofol, sevoflurane, postoperative pain, gastrectomy, intravenous anesthesia, inhalational anesthesia
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