Target Controlled Infusion with Propofol and Propofol Combined Lidocaine Versus Inhalational on Stress Response in Lower Abdominal Surgery

Abstract

Background: This study aimed to investigate the impact of target-controlled infusion (TCI) using propofol alone and propofol combined with lidocaine in comparison to inhalational anesthesia on stress response, by examining serum insulin growth factor (IGF) levels.

Methods: This prospective, randomized study was conducted on 90 patients, with lower abdominal malignancies. Patients were given intravenous anesthesia for induction. They were then divided into three equal groups: group P received propofol through TCI, group S received sevoflurane, and group PL received a combination of propofol and lidocaine TCI. Patients were observed for stress response by serum level of IGF, haemodynamics, BIS, visual analogue scale (VAS), LANSS score and satisfaction score.

Results:  IGF levels were significantly higher in group S. Group S had  greater intraoperative heart rate, mean arterial pressure, and bispectral index score (BIS) than groups P and PL .Fentanyl consumption and the first request for analgesia were significantly different, where group S shows a significantly earlier request for analgesia, while group PL has the longest. Group PL reported lower pain levels than groups P and S according to VAS. Group PL scored lower than groups P and S on the assessment of neuropathic symptoms and signs (LANSS).

Conclusions: TCI propofol lidocaine demonstrated a superior effect compared to TCI propofol and inhalation anesthesia alone. It was associated with stable hemodynamics, lower GF levels, opioid consumption, pain score and longest first request analgesia.