Abdi Alireza, Imani Behzad, Zarei Mohsen, Abdolmaleki Sajjad, Zandi Shirdel, Vosough Roya Najafi
Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran.
BMC Anesthesiol. 2025 Jul 30;25(1):373. doi: 10.1186/s12871-025-03254-0.
General anesthesia is commonly used for spinal surgeries, achieved through inhalational methods or total intravenous anesthesia (TIVA). This study compared propofol-based TIVA with isoflurane anesthesia in patients undergoing posterior lumbar fusion surgery. Primary outcomes - intraoperative blood loss, surgical field quality, and hemodynamic stability - were selected for their direct impact on patient safety and surgical outcomes. Secondary outcomes evaluated recovery characteristics (extubation time, eye-opening, response to commands, and post-anesthesia recovery quality) and postoperative complications (PONV, pain scores).
This randomized clinical trial was conducted in Iran from 2024 to 2025. A total of sixty-six patients were randomly assigned to two groups-Isoflurane and TIVA-using a convenience sampling method. Hemodynamic changes and surgical field quality (Boezaart score) were recorded during the surgery. The recovery characteristics were recorded, including recovery times, and quality of recovery (assessed using the QoR-40 questionnaire). Additionally, complications such as postoperative nausea and vomiting (evaluated using the RINVR questionnaire), blood loss, and pain levels (measured by the Visual Analog Scale [VAS]) were assessed.
The TIVA group significantly reduced intraoperative blood loss and improved surgical field quality. Recovery times, including extubation, eye-opening, and response to verbal commands, were significantly shorter in the TIVA group. The quality of recovery was significantly higher in the TIVA group on the first and second postoperative days. No significant differences between the two groups were observed in hemodynamic stability or the incidence of Postoperative nausea and vomiting (PONV). Postoperative pain scores did not differ significantly, although TIVA patients reported higher pain immediately after surgery.
Propofol-based TIVA may benefit patients undergoing spinal fusion surgery due to reduced blood loss, improved surgical field quality, and faster recovery. However, further research is needed on its effects on hemodynamic stability, pain management, PONV, and long-term outcomes.
This study was registered with the Iranian Clinical Trials Registry under the code IRCT20230208057358N2 on 2024-08-13.
全身麻醉常用于脊柱手术，可通过吸入法或全静脉麻醉（TIVA）实现。本研究比较了接受后路腰椎融合手术患者中丙泊酚全静脉麻醉与异氟烷麻醉的效果。选择术中失血、手术视野质量和血流动力学稳定性作为主要结局指标，因其对患者安全和手术结果有直接影响。次要结局指标评估恢复特征（拔管时间、睁眼、对指令的反应及麻醉后恢复质量）和术后并发症（术后恶心呕吐、疼痛评分）。
本随机临床试验于2024年至2025年在伊朗进行。采用便利抽样法将66例患者随机分为两组——异氟烷组和全静脉麻醉组。手术期间记录血流动力学变化和手术视野质量（博扎尔特评分）。记录恢复特征，包括恢复时间和恢复质量（使用QoR - 40问卷评估）。此外，评估术后恶心呕吐（使用RINVR问卷评估）、失血和疼痛程度（通过视觉模拟量表[VAS]测量）等并发症。
全静脉麻醉组显著减少术中失血并改善手术视野质量。全静脉麻醉组的恢复时间，包括拔管、睁眼和对言语指令的反应，明显更短。术后第一天和第二天，全静脉麻醉组的恢复质量显著更高。两组在血流动力学稳定性或术后恶心呕吐（PONV）发生率方面未观察到显著差异。术后疼痛评分无显著差异，尽管全静脉麻醉组患者术后立即报告疼痛较高。
基于丙泊酚的全静脉麻醉可能使接受脊柱融合手术的患者受益，因为其可减少失血、改善手术视野质量并加快恢复。然而，需要进一步研究其对血流动力学稳定性、疼痛管理、术后恶心呕吐和长期结局的影响。
本研究于2024年8月13日在伊朗临床试验注册中心注册，注册号为IRCT20230208057358N2。
