Effects of total intravenous anaesthesia versus inhalation anaesthesia on gastrointestinal function recovery after laparoscopic hysterectomy: A randomised controlled trial.

BACKGROUND AND AIMS: As gynaecological laparoscopic minimally invasive surgery continues to advance, it becomes essential to explore how inhalation anaesthesia and intravenous anaesthesia affect the recovery of gastrointestinal function after surgery. The objective was to compare the effects of total intravenous anaesthesia (TIVA) and inhalation anaesthesia on the time of the first defecation and the time of consuming solid food for patients following laparoscopic total hysterectomy.

METHODS

This research involved 134 female participants aged 18-65 years, classified as American Society of Anesthesiologists physical status I-II, who were scheduled to undergo elective laparoscopic hysterectomy procedures. Participants were randomly allocated into two cohorts: one receiving TIVA (Group P) (underwent TIVA induction with propofol, remifentanil, and rocuronium administration, supplemented by ongoing administration of propofol-remifentanil infusions), and the other group was administered inhalational anaesthesia (Group S) (using sevoflurane delivered through precise tidal volume ventilation alongside rocuronium, with maintenance achieved through combined sevoflurane inhalation and remifentanil infusion). The primary outcome was the time to initial defecation and tolerance of solid food (SF + D), while the final outcome was determined by the longer duration required to achieve these two outcomes. The I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) score, the numeric rating scale score for pain, and the numeric rating scale score for postoperative nausea and vomiting, the time to first flatus, gastric antral motility index, and intestinal peristalsis rate within 1 minute determined by bedside ultrasound were also recorded.

RESULTS

The mean to first defecation + hard food tolerance (SF + D) was 51 [standard deviation (SD: 8.47)] in Group S and 47 (SD: 9.45) in Group P (P = 0.02), and the mean difference between the groups was - 4.46 (95% CI: 0.20, 7.00). None of the I-FEED scores were statistically significant (P = 0.074, Z = -1.79). Patients in Group P experienced superior analgesic effects and more stable haemodynamics.

CONCLUSION

The postoperative recovery of gastrointestinal function can be enhanced by employing total intravenous anaesthesia instead of inhalation anaesthesia.