Total Intravenous Anesthesia with Propofol Reduces Discharge Times Compared with Inhaled General Anesthesia in...

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Ambulatory Surgery

Background:

• Shoulder arthroscopy commonly uses interscalene block with inhaled general anesthesia (IGA) in ambulatory surgical centers (ASCs).
• Total intravenous anesthesia with propofol (TIVA-P) is an alternative anesthesia technique with potential for reduced recovery times in various surgeries.

Purpose of the Study:

• To compare post-anesthesia care unit phase-I (PACU-I) time between patients undergoing shoulder arthroscopy with interscalene block and IGA versus interscalene block and TIVA-P.
• To assess the clinical significance of differences in PACU-I time and other recovery metrics between the two anesthesia methods.

Main Methods:

• A randomized study involving 96 patients undergoing shoulder arthroscopy at an ASC, comparing interscalene block with IGA versus TIVA-P.
• Primary outcome was PACU-I time; secondary outcomes included pain, satisfaction, antiemetic use, and total discharge time.
• Statistical analysis used chi-square and Mann-Whitney U tests with a significance cutoff of 0.0167 due to interim analyses.

Main Results:

• The TIVA-P group demonstrated significantly shorter median PACU-I time (0.0 minutes) compared to the IGA group (25.5 minutes; p < 0.001).
• Total time until discharge was also shorter in the TIVA-P group (135.5 minutes) versus the IGA group (148.5 minutes; p = 0.0104).
• TIVA-P was associated with reduced antiemetic use (59.5% vs. 92.5%; p = 0.0013) without significant differences in pain or satisfaction.

Conclusions:

• Total intravenous anesthesia with propofol (TIVA-P) offers a potential advantage in reducing PACU-I and total discharge times for shoulder arthroscopy.
• TIVA-P may decrease antiemetic requirements without compromising patient pain control or satisfaction.
• TIVA-P warrants consideration for shoulder arthroscopy procedures in ambulatory surgical centers.