Comparison of inhalation and total intravenous anesthesia on inflammatory markers in microdiscectomy: a double-blind study.

BACKGROUND: The choice of anaesthetic technique has the potential to exert a significant influence on the perioperative stress response, immune modulation and inflammation which are critical factors in surgical recovery. The primary objective of this study was to compare 24-h postoperative IL-6 levels between patients undergoing lumbar microdiscectomy under TIVA or sevoflurane anesthesia. Secondary outcomes included perioperative changes in CRP, NLR and PLR.

METHODS: This prospective, randomised, double-blind study included 40 patients classified as American Society of Anesthesiologists (ASA) I-II and scheduled for elective lumbar disc herniation surgery. Patients were randomly assigned to receive either TIVA with propofol or inhalational anaesthesia with sevoflurane. Interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR) levels were measured at preoperative, intraoperative and postoperative time points.

RESULTS: Postoperative IL-6 levels were significantly lower in the TIVA group than in the sevoflurane group (p < 0.05), with a blunted increase in IL-6 levels from the preoperative to the postoperative phases. Postoperative CRP levels were significantly lower in the TIVA group (p < 0.05), whereas PCT levels remained stable across groups. There were no significant differences between groups in NLR values.

CONCLUSION: The results of this study indicate that TIVA with propofol may offer a superior modulation of inflammatory responses compared to sevoflurane in patients undergoing lumbar microdiscectomy. These findings indicate that TIVA may be a preferred anaesthetic technique for surgical procedures that require precise control of the perioperative inflammatory response. Further studies are required to validate these findings in larger populations and diverse surgical contexts.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT06386965.