Comparison of Total Intravenous Anesthesia Methods in Spinal Surgery (TIVA)

Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital72 enrolled

Overview

This study aims to compare the effects of the classical Total Intravenous Anesthesia (TIVA) method and multimodal anesthesia protocols created by adding lidocaine and ketamine infusions on postoperative pain management, opioid consumption, and surgical recovery in posterior thoracolumbar spinal fusion surgeries. A prospective observational study was conducted with 72 patients undergoing posterior thoracolumbar spinal fusion surgeries. Patients were evenly divided into three groups: classical TIVA (propofol and remifentanil), TIVA + ketamine, and TIVA + lidocaine. Hemodynamic parameters and drug dosages were recorded during the intraoperative period, while pain scores, opioid consumption, time to first ambulation and bowel movement, as well as nausea-vomiting and sedation scores, were documented postoperatively.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Anesthesia

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Aged 18 years or older, * ASA classification I-III * Patients undergoing posterior thoracolumbar spinal surgery and neuromonitoring under general anesthesia Exclusion Criteria: * Emergency operations * Pregnant patients * Patients with ASA classification IV or higher\* * Patients allergic to morphine and local anesthetics * Patients with neurological or psychiatric disorders (on ongoing antidepressant and/or anticonvulsant therapy) Illiterate patients * Patients unable to cooperate * Extremely low or high body weight (less than 40 kg or more than 100 kg) * Chronic opioid use * Diabetes mellitus (DM) requiring insulin therapy * Chronic alcohol use * Patients with peripheral neuropathy * Patients with cardiac arrhythmias

Outcomes

Primary Outcomes

Postoperative Pain Score Using Visual Analog Scale (VAS)

Pain levels will be assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain), at 30 minutes, 2 hours, 6 hours, 12 hours, and 24 hours postoperatively.

Time frame: postoperative 24 hours

Total Opioid Consumption in the First 24 Hours Postoperatively

The total amount of opioids administered during the first 24 hours postoperatively will be recorded and converted to morphine milligram equivalents (MME).

Time frame: Postoperative 24 hours

Secondary Outcomes

Time to First Ambulation After Surgery

The time from the end of surgery to the patient's first ambulation will be recorded in hours.

Time frame: postoperative 24 hours

Time to First Bowel Movement After Surgery

The time from the end of surgery to the patient's first reported bowel movement will be recorded in hours.

Time frame: postoperative 24 hours

Incidence of Nausea and Vomiting

The presence of postoperative nausea and vomiting will be recorded within the first 24 hours after surgery.

Time frame: postoperative 24 hours

Opioid Requirement Within After Surgery

The need for opioid use within 1 month after discharge will be evaluated through follow-up phone calls. The percentage of patients requiring opioids during this period will be recorded.

Time frame: postoperative 1 month

Comparison of Total Intravenous Anesthesia Methods in Spinal Surgery (TIVA)

Overview

Conditions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes