The effect of total intravenous versus inhalation anesthesia on early postoperative pain after laparoscopic cholecystectomy: A randomized controlled trial from Eastern Libya: Propofol versus isoflurane for early postoperative pain

Hamza M. Alhussadi; Saja S. Noisari; Esraa M. Alhassi; Salim M. Makhlouf

doi:10.28982/josam.8412

Authors

Hamza M. Alhussadi Department of Anesthesia and Critical Care, College of Medical Technology, Derna, Libya https://orcid.org/0009-0000-1941-0980
Saja S. Noisari The College of Medical Technology, Derna, Libya https://orcid.org/0009-0002-1635-4957
Esraa M. Alhassi The College of Medical Technology, Derna, Libya https://orcid.org/0009-0007-0774-5637
Salim M. Makhlouf The College of Medical Technology, Derna, Libya https://orcid.org/0000-0002-1567-7757

DOI:

https://doi.org/10.28982/josam.8412

Keywords:

Propofol, isoflurane, laparoscopic cholecystectomy, postoperative pain, Libya

Abstract

Background/Aim: Effective postoperative pain (POP) control remains a major determinant of recovery after laparoscopic cholecystectomy (LC), particularly in resource-limited healthcare settings such as Libya. Although propofol-based total intravenous anesthesia (TIVA) may improve early analgesia compared with isoflurane-based inhalation anesthesia (IA), comparative evidence from these settings is limited. This trial compared acute POP trajectories during the first 24 hours after LC under these two anesthetic techniques in Eastern Libya.

Methods: This prospective, double-blind, randomized controlled trial was conducted at two public hospitals in Eastern Libya between February and May 2025. Fifty-nine patients scheduled for elective LC were analyzed after randomization to propofol-based TIVA (n = 29) or isoflurane-based IA (n = 30). The primary outcome was pain intensity measured with the Numerical Rating Scale (NRS; 0-10) at 2, 6, 12, and 24 hours postoperatively. Data were analyzed using SPSS version 26.

Results: A significant anesthesia-by-time interaction was observed for postoperative pain scores (F[2.92, 166.63] = 11.67, P < 0.001). Pairwise comparisons showed lower mean pain scores in the TIVA group at 2 hours [4.3 (0.8) vs. 4.8 (0.8), P = 0.010] and 12 hours [2.2 (0.5) vs. 2.7 (0.6), P = 0.001]. The 6-hour difference was smaller [3.2 (0.6) vs. 3.4 (0.7), P = 0.028], and no significant difference was observed at 24 hours [1.5 (0.3) vs. 1.7 (0.4), P = 0.063]. The main effect of anesthetic type was not significant (F[1, 57] = 2.21, P = 0.143).

Conclusion: Propofol-based TIVA was associated with modestly lower early postoperative pain scores after LC compared with isoflurane-based IA, but this benefit was not sustained at 24 hours. Selection of anesthetic technique should consider whether early POP control is a clinical priority within the broader multimodal analgesia strategy.

Downloads

Download data is not yet available.

References

Zhao HX, Han L, Wang D, Jin J, Ji FH, Guo W, et al. Impact of opioid-free anesthesia on the overall benefit of analgesia score after laparoscopic cholecystectomy: protocol and statistical analysis plan for a multicenter, randomized, controlled trial. Ann Med. 2025 Dec;57(1):2589570. doi: 10.1080/07853890.2025.2589570.

Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90(3):261-9. doi: 10.1016/S0304-3959(00)00406-1.

Makhlouf SM, Algabaily AK, Hawil MR, Albkouri FO. Prevalence of acute postoperative pain with risk factors following appendectomy and cholecystectomy in tertiary hospitals in Eastern Libya. Indian J Pain. 2025;39(1):29-35.

Jones C, Harris J. Total intravenous anaesthesia. Br J Hosp Med (Lond). 2021;82(6):1-2. doi: 10.12968/hmed.2021.0190.

Richebé P, Brulotte V. Anaesthesia maintenance with propofol versus sevoflurane to reduce postoperative pain: Still too early for recommendations? Eur J Pain. 2019;23(5):847-8. doi: 10.1002/ejp.1385.

Lin WL, Lee MS, Wong CS, Chan SM, Lai HC, Wu ZF, et al. Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: Comparison with desflurane anesthesia - a randomised trial. Medicine (Baltimore). 2019;98(13):e15074. doi: 10.1097/MD.0000000000015074.

Matta JA, Cornett PM, Miyares RL, Abe K, Sahibzada N, Ahern GP. General anesthetics activate a nociceptive ion channel to enhance pain and inflammation. Proc Natl Acad Sci U S A. 2008;105(25):8784-9. doi: 10.1073/pnas.0711038105.

Cheng SS, Yeh J, Flood P. Anesthesia matters: Patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg. 2008;106(1):264-9.

Wong SSC, Choi EKY, Chan WS, Cheung CW. Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: A large-scale retrospective study with covariate adjustment. BMC Anesthesiol. 2022;22(1):140. doi: 10.1186/s12871-022-01683-9.

Ortiz J, Chang LC, Tolpin DA, Minard CG, Scott BG, Rivers JM. Randomized, controlled trial comparing the effects of anesthesia with propofol, isoflurane, desflurane, and sevoflurane on pain after laparoscopic cholecystectomy. Braz J Anesthesiol. 2014;64(3):145-51. doi: 10.1016/j.bjane.2013.03.011.

Peng K, Liu HY, Wu SR, Liu H, Zhang ZC, Ji FH. Does propofol anesthesia lead to less postoperative pain compared with inhalational anesthesia? A systematic review and meta-analysis. Anesth Analg. 2016;123(4):846-58. doi: 10.1213/ANE.0000000000001504.

Wong SSC, Leung MYY, Cheung CW. The effect of total intravenous anaesthesia with propofol on postoperative pain after third molar surgery: A double-blind randomized controlled trial. Eur J Pain. 2019;23(5):884-93. doi: 10.1002/ejp.1354.

Raeder JC, Mjåland O, Aasbø V, Grøgaard B, Buanes T. Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 1998;42(1):106-10. doi: 10.1111/j.1399-6576.1998.tb05089.x.

Tan T, Bhinder R, Carey M, Briggs L. Day-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane. Anesth Analg. 2010;111(1):83-5. doi: 10.1213/ANE.0b013e3181c0ee9e.

Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.

Gan TJ. Poorly controlled postoperative pain: Prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98. doi: 10.2147/JPR.S144066.

Makhlouf SM. Postoperative pain management outcomes at a Libyan hospital: A cross-sectional survey. Int J Pain. 2024;15(2):88-97. doi: 10.56718/ijp.24-020.

Wong SSC, Chan WS, Irwin MG, Cheung CW. Total intravenous anesthesia (TIVA) with propofol for acute postoperative pain: A scoping review of randomized controlled trials. Asian J Anesthesiol. 2020;58(3):79-93. doi: 10.6859/aja.202009_58(3).0001.

Amiri AA, Karvandian K, Rahimi M, Ashouri M, Amiri AA. Postoperative nausea and vomiting and postoperative pain in patients undergoing elective laparoscopy; comparison of total intravenous anesthesia versus inhalational anesthesia: A randomized clinical trial. Arch Anesthesiol Crit Care. 2020;6(2):71-7. doi: 10.18502/aacc.v6i2.2759.

Sharma SK, Thakur K, Mudgal SK, Payal YS. Acute postoperative pain experiences and satisfaction with its management among patients with elective surgery: An observational study. Indian J Anaesth. 2020;64(5):403-8. doi: 10.4103/ija.IJA_33_20.

Bimrew D, Misganaw A, Samuel H, Desta TD, Bayable SD. Incidence and associated factors of acute postoperative pain within the first 24 h in women undergoing cesarean delivery at a resource-limited setting in Addis Ababa, Ethiopia: A prospective observational study. SAGE Open Med. 2022;10:20503121221133190. doi: 10.1177/20503121221133190.

van Boekel RLM, Steegers MAH, van Noord I, van de Sande R, Vissers KCP. Acute pain services and postsurgical pain management in the Netherlands: A survey. Pain Pract. 2015;15(5):447-54. doi: 10.1111/papr.12192.