Title : Comparison between total intravenous anesthesia and balanced anesthesia on postoperative opioid consumption in patients who underwent laparoscopic-assisted distal gastrectomy
Introduction: Remifentanil is the most widely used opioid for total intravenous anesthesia (TIVA) or balanced anesthesia (BA) due to its favorable pharmacological properties. However, opioid-induced hyperalgesia and/or acute tolerance after intraoperative use of remifentanil have been repeatedly reported. In addition, it is important to effectively control postoperative pain with less opioid. Therefore, we compare TIVA with propofol-remifentanil and BA with desflurane-remifentanil on opioid consumption to control postoperative pain in patients underwent laparoscopic-assisted distal gastrectomy with gastroduodenostomy. Methods: We retrospectively reviewed the electronic medical records of patients underwent laparoscopic-assisted distal gastrectomy with gastroduodenostomy due to early stomach cancer for demographic variables (age, gender, height, weight, and smoking), the duration of general anesthesia, and intraoperatively administered remifentanil consumption. The primary outcome was postoperative opioid consumption during postoperative day 2. The secondary outcomes were the incidence of any rescue opioid analgesics administered, numeric rating scale, and various adverse effects during postoperative day 2. We divided all data according to 2 patient groups to compare TIVA with propofol-remifentanil (TIVA group) versus BA with desflurane-remifentanil (BA group) on the postoperative opioid analgesic consumption in patients. Results: In total, 114 patients were divided into the TIVA (46 patients) and BA (68 patients) groups. Opioid consumption as a primary outcome was significantly higher in the BA group than in the TIVA group during postoperative day 2 except in the post-anesthesia care unit. The cumulative opioid consumption was significantly higher in the BA than in the TIVA group. The incidence of rescue analgesic at postoperative day 2 was higher in the BA than in the TIVA group. In the TIVA group, remifentanil consumption was higher, and the duration of general anesthesia was shorter than that in the BA group. No statistically significant differences were observed for other variables. Conclusion: This study suggests that the maintenance of general anesthesia with TIVA (propofol-remifentanil) reduces opioid consumption for postoperative pain control compared to BA (desflurane-remifentanil) in patients undergoing laparoscopic-assisted distal gastrectomy with gastroduodenostomy.