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Total intravenous anesthesia (TIVA) with propofol may improve acute postoperative pain control compared to inhalational anesthesia. The objective of this review was to comprehensively update and evaluate the existing literature on the analgesic efficacy of propofol TIVA. A systemized literature search for randomized controlled trials in adult patients was conducted in the PubMed and Cochrane CENTRAL (EMBASE source) databases up to August 2019. Clinical trials included compared propofol TIVA against inhalational isoflurane, sevoflurane, or desflurane. Only clinical trials that studied acute postoperative pain scores or analgesic consumption as a primary outcome were included. Sixteen randomized controlled trials were included. Surgical procedures evaluated included: radical gastrectomy, open vein stripping, breast cancer surgery, laparoscopic cholecystectomy, inguinal herniotomy, abdominoplasty, bariatric surgery, lumbar spine surgery, emergency neurosurgical operations, open and laparoscopic gynecological surgeries, and dental surgery. Propofol TIVA was associated with reduced postoperative pain scores and/or decreased opioid consumption in 9 out of 16 clinical trials. There was no difference in 5 clinical trials, and propofol TIVA was associated with worse analgesic outcomes in 2 trials. Propofol TIVA may improve acute postoperative analgesia after surgery, but different factors such as surgical procedures and anesthetic/analgesic techniques may influence its effectiveness.

Total Intravenous Anesthesia (TIVA) With Propofol for Acute Postoperative Pain: A Scoping Review of Randomized Controlled Trials.