The comparison of total intravenous anesthesia and inhalation anesthesia effects on postoperative recovery by quality of recovery (QoR-40) in septorhinoplasty: a randomized trial

Postoperative recovery is a multidimensional outcome that reflects patients’ physical, psychological, and functional well-being after surgery. Although total intravenous anesthesia (TIVA) and inhalational anesthesia are widely used for maintenance of general anesthesia, their effects on postoperative recovery quality remain controversial. This study aimed to compare the effects of propofol-based TIVA and sevoflurane-based inhalational anesthesia on postoperative recovery quality in patients undergoing elective septorhinoplasty. In this prospective, randomized, single-center, assessor-blinded trial, 92 patients scheduled for elective septorhinoplasty under general anesthesia were randomly assigned to receive either propofol-based TIVA or sevoflurane-based inhalational anesthesia. The primary outcome was postoperative recovery quality assessed 24 h after surgery using the Quality of Recovery-40 questionnaire, including both the global score and its five dimensions: physical comfort, emotional state, physical independence, psychological support, and pain. Secondary outcomes included extubation time, recovery time, postoperative pain scores, rescue analgesic requirements, and postoperative nausea and vomiting. A total of 89 patients completed the study (TIVA, n = 45; inhalational anesthesia, n = 44). Postoperative global Quality of Recovery-40 scores were comparable between the groups (187 [181–192] vs. 184.5 [158.8–192], p = 0.182). No significant differences were observed in any of the five recovery domains. Postoperative pain scores were significantly lower in the TIVA group (3 [1–3] vs. 3 [2–5], p = 0.034). However, rescue analgesic requirements, incidence of postoperative nausea and vomiting, extubation time, recovery time, and post-anesthesia care unit stay did not differ significantly between groups. Total remifentanil consumption was significantly higher in the TIVA group ( p = 0.003). Propofol-based TIVA and sevoflurane-based inhalational anesthesia provided comparable postoperative recovery quality following elective septorhinoplasty. Although TIVA was associated with lower postoperative pain scores, this advantage did not result in improved overall recovery quality or other clinically relevant recovery outcomes. These findings suggest that anesthetic maintenance technique alone may have a limited impact on patient-perceived recovery when contemporary perioperative care protocols are applied. ClinicalTrials.gov, NCT06423313. Registered on May 17, 2024.