New Research Highlights TIVA’s Advantage in Reducing Inflammation During Microdiscectomy

The Anesthesia Dilemma: Does Technique Influence Recovery?

When it comes to surgical recovery, the choice of anesthesia may be more than just a technical detail—it could shape the body’s response to stress and inflammation. A recent double-blind study published in BMC Anesthesiology explores whether total intravenous anesthesia (TIVA) with propofol or inhalation anesthesia with sevoflurane offers a better profile for controlling perioperative inflammation in lumbar microdiscectomy patients.

Study Design: A Closer Look at Inflammatory Markers

The research involved 40 patients, aged 18–65, undergoing elective lumbar disc herniation surgery. They were randomized to receive either TIVA (propofol-based) or sevoflurane anesthesia. The key focus was on measuring and comparing interleukin-6 (IL-6)—a core inflammatory cytokine—at multiple timepoints before, during, and after surgery. Additional markers included C-reactive protein (CRP), procalcitonin (PCT), and the neutrophil-to-lymphocyte ratio (NLR).

Key Findings: TIVA Damps Down the Inflammatory Surge

Both anesthesia approaches led to increased IL-6 after surgery, but the rise was significantly less pronounced in the TIVA group. At 24 hours post-surgery, IL-6 levels in TIVA patients were markedly lower compared to those who received sevoflurane. Similarly, CRP levels—a general marker of inflammation—were also lower with TIVA. PCT levels, often linked to infection, remained stable and similar between groups, and NLR values did not show significant differences postoperatively.

Why Does This Matter?

Excessive or poorly controlled inflammation can slow healing, increase infection risk, and complicate recovery. The study’s results suggest that TIVA with propofol may help better modulate this response, potentially offering patients smoother recoveries. Interestingly, although many previous studies focused on cancer or major surgeries, this research zeroed in on a minimally invasive, non-oncologic procedure—giving new insight into anesthesia’s impact in routine spine surgery.

Weighing the Evidence: Practical Implications and Next Steps

While the study found no difference in length of hospital stay or immediate complications, the findings raise the possibility that TIVA could be the preferred option when minimizing surgical inflammation is a priority. However, larger and more diverse studies are needed to confirm these results, assess long-term outcomes, and determine if the benefits translate to other patient populations or types of surgery.

Key Takeaways

TIVA with propofol led to significantly lower postoperative IL-6 and CRP levels compared to sevoflurane in microdiscectomy.

No differences were observed in PCT (infection marker) or postoperative NLR values.

Both anesthesia techniques were safe, with no difference in complications or hospital stay.

TIVA may offer a real advantage for patients needing tight inflammation control during surgery.

Further large-scale, multicenter studies are warranted to expand on these promising findings.

Citation:

Yediyıldız MB, Durmuş İ, Yılmaz Ak H, Taşkın K, Devrüş Ceylan MA, Yüce Y, Çevik B, Aydoğmuş E. Comparison of inhalation and total intravenous anesthesia on inflammatory markers in microdiscectomy: a double-blind study. BMC Anesthesiology. 2025;25:238. https://doi.org/10.1186/s12871-025-03119-6