Comparison between Total Intravenous Anesthesia (TIVA) versus Inhalational Anesthesia in Laparoscopic Sleeve Gastrectomy: A Randomized Clinical Trial

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is a cornerstone of bariatric surgery, requiring optimized anesthesia to ensure patient safety and postoperative recovery. Total Intravenous Anesthesia (TIVA) and inhalational anesthesia are commonly employed, yet their comparative efficacy in LSG remains underexplored. This study evaluates TIVA versus Inhalational Anesthesia in LSG, focusing on recovery time, hospital length of stay (LOS), postoperative nausea and vomiting (PONV), pain scores, and adverse events.

Methods: A randomized clinical trial (RCT) was conducted on 70 patients undergoing LSG between January 2024 and June 2025. The study data were collected in general operating rooms by an anesthesia assistant and colleagues at the Imam Khomaini Hospital Complex of tehran. Patients were randomly assigned to TIVA (n=35) or inhalational (n=35) groups using a computer-generated randomization sequence.

Primary outcomes included recovery time, LOS, and PONV incidence. Secondary outcomes included Visual Analog Scale (VAS) pain scores at 15, 30, 45, and 60 minutes post-surgery and adverse events (hypotension, bradycardia). Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables, with significance set at p<0.05.

Results: TIVA significantly reduced recovery time (21.1 ± 15.2 vs. 34.6 ± 20.3 minutes, p<0.05) and PONV incidence (20% vs. 34.5%, p<0.01) compared to inhalational anesthesia. VAS scores were lower in the TIVA group at 15 minutes (5.2 ± 1.8 vs. 6.8 ± 1.5, p<0.05) and 30 minutes (5.0 ± 1.7 vs. 6.5 ± 1.6, p<0.05), with no significant differences at 45 or 60 minutes. LOS was comparable (2.4 ± 0.7 vs. 2.7 ± 0.9 days, p=0.15). Subgroup analyses showed TIVA’s superior recovery time in women (p<0.05) and the 30-40 age group (p<0.05). Adverse events were similar between groups.

Conclusion: TIVA offers faster recovery and lower PONV rates compared to inhalational anesthesia in LSG, particularly in women and patients aged 30-40 years. These findings advocate for TIVA as a preferred anesthetic strategy in LSG to enhance postoperative outcomes.