| Objective: Propofol and sevoflurane are currently commonly used general anesthetics.Previous clinical studies have shown that both can affect the incidence of postoperative pain and the amount of postoperative opioid use,but the final statement cannot be reached.We therefore assessed the effect of maintenance of sevoflurane or propofol anesthesia on the incidence of postoperative pain in chronic pain patients undergoing total knee arthroplasty（TKA）.Methods:1.Study subjects and groups: We selected 97 patients who were scheduled to undergo elective TKA at our hospital and had a preoperative VAS score >4 for observation.They were randomly assigned to sevoflurane（group S,n = 50）or propofol（group P,n = 47）.2.Anesthesia method: The two groups of patients first received femoral nerve block（FNB）combined with sciatic nerve block（SNB）operation,and then underwent general anesthesia induction.The patients in group P maintained the depth of anesthesia by continuous pumping of propofol during the operation,and the patients in group S continued to inhale sevoflurane to meet the requirements for anesthesia during surgery.3.Outcome measures:3.1 Main outcome measures: By recording the results of the pain/discomfort dimension in the Euro Qol five-dimension questionnaire（EQ-5D）,the incidence of pain was compared between the two groups of TKA patients on postoperative day 1,day 3,day 7,month 1,and month 3.3.2 Secondary indicators: We compared the EQ-5D scores on day 1,day 3,day 7,month 1,and month 3 after TKA between the two groups of patients,the use of opioids within 72 hours after surgery and the incidence of delirium 3 days after surgery were also observed in the two groups.Results: Fewer patients in the sevoflurane group reported moderate pain（p = 0.001）and more patients reported no pain（p = 0.003）compared with the propofol group at postoperative day 3.Likewise,at 3 months postoperatively,more patients in the S group reported no pain（p = 0.04）and fewer patients reported moderate pain（p = 0.04）compared with the P group.There was no significant difference in the incidence of postoperative pain between the two groups at other time points.Results for postoperative opioid consumption and incidence of postoperative delirium were similar for both anesthetics,with no statistically significant differences.The EQ-5D score on the first day after TKA decreased to a minimum,and continued to increase in both groups during the 3-month follow-up period,reaching a maximum at the last follow-up visit.Quality of life was improved in both groups at the last assessment compared to preoperatively.During the 3-month follow-up period,the EQ-5D score of patients in group S was generally higher than that of patients in group P（p = 0.022）,but the absolute value of the difference between the two groups was small,and the maximum value was only 0.15.Therefore,we do not consider the EQ-5D results to be clinically meaningful.Conclusion: Sevoflurane anesthesia may have potential advantages in reducing postoperative pain in patients undergoing TKA with a preoperative VAS score > 4.However,sevoflurane and propofol showed little difference in postoperative quality of life. |
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