The recovery of total intravenous anesthesia vs inhalational anesthesia in opioid free pediatric tonsillectomy

Abstract

Background: Ambulatory pediatric tonsillectomy requires anesthetic techniques that enable rapid, smooth emergence and early discharge with minimal postoperative adverse events. Although total intravenous anesthesia (TIVA) and inhalational anesthesia are commonly used, their relative effects on fast-track recovery within an opioid-free regimen remain inadequately characterized. Objective: To compare opioid-free TIVA using propofol with inhalational anesthesia using sevoflurane regarding emergence profile and fast-track recovery in ambulatory pediatric tonsillectomy. Methods: This prospective randomized study enrolled 120 ASA I children aged 3-10 years with Mallampati class I–II undergoing ambulatory tonsillectomy. Participants were randomized into two equal groups: propofol-based TIVA via a manually programmed infusion (Group P, n = 60) or sevoflurane inhalational anesthesia (Group S, n = 60). All patients received a standardized opioid-free analgesic protocol. Recovery outcomes were assessed using White’s Fast-Track Score, along with postoperative pain, postoperative nausea and vomiting (PONV), and time to discharge.Results: Baseline demographics and intraoperative physiological parameters were comparable between groups (p > 0.05). Group P showed superior recovery outcomes, including higher consciousness scores (1.9 ± 0.3 vs 1.67 ± 0.48; p = 0.002), improved PONV-related recov- ery (1.88 ± 0.32 vs 1.23 ± 0.43; p < 0.001; indicating less PONV), higher postoperative pain scores as reported (1.97 ± 0.18 vs 1.82 ± 0.39; p = 0.008), higher total Fast-Track discharge scores (13.48 ± 0.62 vs 12.55 ± 0.62; p < 0.001), and shorter discharge times (16.3 ± 1.51 min vs 20.25 ± 1.11 min; p < 0.001). Physical activity, hemodynamic stability, respiratory stability, and oxygen saturation did not differ significantly between groups. Conclusion: In opioid-free ambulatory pediatric tonsillectomy, propofol-based TIVA was associated with smoother emergence, faster fast-track recovery, reduced PONV, and earlier discharge compared with sevoflurane inhalational anesthesia, without compromising cardiorespi- ratory stability.