Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair

Christopher Rennie; Katerina N Futch; Jane C Brennan; Benjamin M Petre; Sohail Zaidi; Justin J Turcotte; Andrea H Johnson; Daniel E Redziniak

doi:10.7759/cureus.50775

Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair

Cureus. 2023 Dec 19;15(12):e50775. doi: 10.7759/cureus.50775. eCollection 2023 Dec.

Authors

Christopher Rennie^{1

2}, Katerina N Futch^{1

2}, Jane C Brennan², Benjamin M Petre³, Sohail Zaidi⁴, Justin J Turcotte², Andrea H Johnson⁵, Daniel E Redziniak³

Affiliations

¹ Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa, USA.
² Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA.
³ Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA.
⁴ Anesthesiology, Anne Arundel Medical Center, Annapolis, USA.
⁵ Orthopedics, Anne Arundel Medical Center, Annapolis, USA.

Abstract

Background Inhalation anesthesia (IA) and total intravenous anesthesia (TIVA) are common general anesthesia techniques. During rotator cuff repair (RCR), an interscalene block is beneficial for intraoperative and early postoperative pain control. This study aimed to evaluate postoperative outcomes and opioid usage in patients undergoing arthroscopic RCR with an interscalene block and either IA or TIVA. Methodology A retrospective observational study was performed of 478 patients undergoing RCR at a single institution. Demographics, surgical details, intra and postoperative medications, and 90-day outcomes were collected. Univariate and multivariate analyses were performed to evaluate differences between groups. Results In total, 309 (64.6%) patients received IA and 169 (35.3%) received TIVA. Patients receiving IA were more likely to have comorbidities, such as diabetes (p = 0.002), sleep apnea (p = 0.006), gastroesophageal reflux disease (p < 0.001), and hypertension (p < 0.001). After adjusting for differences between groups in the multivariate analysis, patients who received TIVA had significantly shorter surgical time (β = -14.85, p < 0.001) and perioperative time (β = -21.01, p < 0.001) and significantly lower first post-anesthesia care unit Pasero opioid-induced sedation scores (β = -0.022, p = 0.040). Patients who received TIVA were less likely to receive intraoperative narcotics (odds ratio = 0.38; p = 0.031). Conclusions TIVA appears to be a safe and effective anesthetic for patients undergoing arthroscopic RCR. TIVA is a potentially beneficial alternative to IA for this patient population.

Keywords: arthroscopic rotator cuff repair; inhalational anesthesia; narcotic use; postoperative outcomes; postoperative pain; total intravenous anesthesia (tiva).