The effect of isoflurane versus propofol-based total intravenous anesthesia on hemodynamic stability, intraoperative blood loss, surgical field quality, recovery characteristics, and complications in patients undergoing posterior lumbar fusion surgery: a randomized clinical trial

Abstract Introduction General anesthesia is commonly used for spinal surgeries, achieved through inhalational methods or total intravenous anesthesia (TIVA). This study compared propofol-based TIVA with isoflurane anesthesia in patients undergoing posterior lumbar fusion surgery. Primary outcomes - intraoperative blood loss, surgical field quality, and hemodynamic stability - were selected for their direct impact on patient safety and surgical outcomes. Secondary outcomes evaluated recovery characteristics (extubation time, eye-opening, response to commands, and post-anesthesia recovery quality) and postoperative complications (PONV, pain scores). Methods This randomized clinical trial was conducted in Iran from 2024 to 2025. A total of sixty-six patients were randomly assigned to two groups—Isoflurane and TIVA—using a convenience sampling method. Hemodynamic changes and surgical field quality (Boezaart score) were recorded during the surgery. The recovery characteristics were recorded, including recovery times, and quality of recovery (assessed using the QoR-40 questionnaire). Additionally, complications such as postoperative nausea and vomiting (evaluated using the RINVR questionnaire), blood loss, and pain levels (measured by the Visual Analog Scale [VAS]) were assessed. Results The TIVA group significantly reduced intraoperative blood loss and improved surgical field quality. Recovery times, including extubation, eye-opening, and response to verbal commands, were significantly shorter in the TIVA group. The quality of recovery was significantly higher in the TIVA group on the first and second postoperative days. No significant differences between the two groups were observed in hemodynamic stability or the incidence of Postoperative nausea and vomiting (PONV). Postoperative pain scores did not differ significantly, although TIVA patients reported higher pain immediately after surgery. Conclusion Propofol-based TIVA may benefit patients undergoing spinal fusion surgery due to reduced blood loss, improved surgical field quality, and faster recovery. However, further research is needed on its effects on hemodynamic stability, pain management, PONV, and long-term outcomes. Trial registration This study was registered with the Iranian Clinical Trials Registry under the code IRCT20230208057358N2 on 2024-08-13.

Abstract licence: CC BY-NC-ND

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