Discussion
postoperative pain, lower acute postoperative pain, reduced nausea and constipation, acute postoperative pain, Postoperative pain, pain, NRS pain, nausea and constipation
ADVERSE EVENTS
There were no differences in overall acute postoperative analgesia after hepatectomy in terms of NRS pain scores and postoperative PCA morphine consumption between patients who received propofol TIVA and inhalational sevoflurane. Patients in the TIVA group had lower pain scores with coughing at 3 months after surgery. Propofol TIVA was associated with reduced nausea and constipation, as well as better quality of recovery (QoR) on POD 3. The analgesic effect of propofol TIVA for acute postoperative pain control is not certain. A previous meta-analysis showed a small reduction in postoperative pain intensity and opioid consumption with propofol TIVA [Postoperative pain control after hepatic surgery can be challenging to manage. Hepatic surgery is associated with upper abdominal wounds, which results in more severe postoperative pain when compared to lower abdominal wounds, especially with coughing [Patients in the TIVA group had reduced nausea and constipation, and better quality of recovery on POD 3. The quality of recovery (QoR) score is a measure of the health-related quality of life after surgery and anaesthesia [In a previous retrospective case–control study, propofol TIVA was associated with lower acute postoperative pain scores and postoperative opioid consumption after hepatobiliary and pancreatic surgeries [There were some limitations in this randomized controlled trial. The first limitation was a relatively small sample size. The sample size was calculated based on our previous retrospective study on hepatobiliary and pancreatic surgery, which was not only restricted to hepatectomy [In conclusion, propofol TIVA did not improve postoperative pain scores or reduce opioid consumption after hepatectomy when compared to inhalational anaesthesia. Propofol TIVA was associated with better QoR on POD 3 and lower pain scores with coughing at 3 months after surgery. It was also associated with a lower incidence of nausea and constipation, which is not likely related to propofol’s analgesic effect. Our results do not support the use of propofol TIVA for the purpose of reducing acute postoperative pain after hepatectomy when used together with ketamine. However, other outcomes such as effects on adverse events and quality of recovery should be considered when choosing between general anaesthetic techniques.