{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:05:18Z","timestamp":1790888718711,"version":"4.1.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7,3]]},"abstract":"\n Background:<\/jats:title>\n Shoulder arthroscopy is commonly performed at ambulatory surgical centers (ASCs) with use of an interscalene block and inhaled general anesthesia (IGA). However, an alternative option known as total intravenous anesthesia with propofol (TIVA-P) has shown promising results in reducing recovery time for other surgeries. The objective of this study was to assess whether there is a clinically meaningful difference in post-anesthesia care unit phase-I (PACU-I) time following shoulder arthroscopy between patients receiving an interscalene block with IGA and those receiving an interscalene block with TIVA-P.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Patients who underwent shoulder arthroscopy performed by a single surgeon at the ASC of our institution between 2020 and 2023 were enrolled. Enrollment was conducted in blocks, with up to 3 planned interim analyses. After 2 blocks, enrollment was halted because the study arms demonstrated a significant difference in the primary outcome measure, PACU-I time. A total of 96 patients were randomized into the TIVA-P and IGA groups; after patient withdrawals, the groups comprised 42 and 40 patients, respectively. Patients underwent shoulder arthroscopy with use of the anesthesia method corresponding to their assigned group. Pain, satisfaction, antiemetic use, perioperative interventions, surgical time, PACU-II time, postoperative care time, and total time until discharge were recorded and were analyzed with use of chi-square and Mann-Whitney U tests with a significance cutoff of 0.0167 to account for the interim analyses.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Across groups, 81.7% of patients were non-Hispanic White and 58.5% were male. Significant differences were observed between the TIVA-P and IGA groups with respect to median PACU-I time (0.0 minutes [interquartile range (IQR), 0.0 to 6.0 minutes] versus 25.5 minutes [IQR, 20.5 to 32.5 minutes]; p < 0.001) and median total time until discharge (135.5 minutes [IQR, 118.5 to 156.8 minutes] versus 148.5 minutes [IQR, 133.8 to 168.8 minutes]; p = 0.0104). The TIVA-P group had a 9.1% quicker discharge time, primarily as a result of bypassing PACU-I (66.7% of patients) and spending 25.5 fewer minutes there overall. The TIVA-P group also had a lower rate of antiemetic use than the IGA group (59.5% versus 92.5% of patients; p = 0.0013). No significant differences were detected between the TIVA-P and IGA groups in terms of median pain improvement (1.0 [IQR, 0.0 to 2.0] versus 1.0 [IQR, 0.0 to 2.0]; p = 0.6734), perioperative interventions (78.6% versus 77.5% of patients, p = 1.0000), or median patient satisfaction (4.0 [IQR, 4.0 to 4.0] versus 4.0 [IQR, 3.8 to 4.0]; p = 0.4148).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n TIVA-P showed potential to improve both PACU-I time and the total time until discharge while reducing antiemetic use without impacting pain or satisfaction. TIVA-P thus warrants consideration by orthopaedic surgeons for use in shoulder arthroscopy performed at ASCs.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level I<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.23.00954","type":"journal-article","created":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T14:00:36Z","timestamp":1712757636000},"page":"1154-1161","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Total Intravenous Anesthesia with Propofol Reduces Discharge Times Compared with Inhaled General Anesthesia in Shoulder Arthroscopy"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5141-6298","authenticated-orcid":false,"given":"Kory J.","family":"Cablay","sequence":"first","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2206-0530","authenticated-orcid":false,"given":"Lucas A.","family":"Arney","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0948-2942","authenticated-orcid":false,"given":"Nicholas J.","family":"Peterman","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6056-0245","authenticated-orcid":false,"given":"Andrea A.","family":"Yu-Shan","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6081-8440","authenticated-orcid":false,"given":"Ali","family":"Kazemi","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3265-9819","authenticated-orcid":false,"given":"Julie A.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-5786","authenticated-orcid":false,"given":"John R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"},{"name":"Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,4,10]]},"reference":[{"issue":"12","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"e1917315","DOI":"10.1001\/jamanetworkopen.2019.17315","article-title":"US Geographical Variation in Rates of Shoulder and Knee Arthroscopy and Association With Orthopedist Density","volume":"2","author":"Jain","year":"2019","journal-title":"JAMA Netw Open."},{"key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"e069901","DOI":"10.1136\/bmj-2021-069901","article-title":"Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study","volume":"378","author":"Rees","year":"2022","journal-title":"BMJ."},{"issue":"3","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"e3507","DOI":"10.1097\/GOX.0000000000003507","article-title":"Wide-awake Local Anesthesia with No Tourniquet: An Updated 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Decrease Discharge Delays: A Process Improvement Plan","volume":"36","author":"Rice","year":"2021","journal-title":"J Perianesth Nurs."},{"issue":"1","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/00000542-200207000-00010","article-title":"Eliminating intensive postoperative care in same-day surgery patients using short-acting anesthetics","volume":"97","author":"Apfelbaum","year":"2002","journal-title":"Anesthesiology."},{"issue":"3","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1213\/00000539-199909000-00022","article-title":"Which clinical anesthesia outcomes are important to avoid? The perspective of patients","volume":"89","author":"Macario","year":"1999","journal-title":"Anesth Analg."},{"key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"6852857","DOI":"10.1155\/2018\/6852857","article-title":"Metabolic Profiles of Propofol and Fospropofol: Clinical and Forensic Interpretative Aspects","volume":"2018","author":"Dinis-Oliveira","year":"2018","journal-title":"Biomed Res Int."},{"issue":"1","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s12871-018-0632-3","article-title":"Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis","volume":"18","author":"Schraag","year":"2018","journal-title":"BMC Anesthesiol."},{"issue":"7","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jval.2021.01.008","article-title":"Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States","volume":"24","author":"Kampmeier","year":"2021","journal-title":"Value Health."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.00954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:03Z","timestamp":1787751843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.00954"}},"subtitle":["A Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2024,4,10]]},"references-count":13,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.23.00954","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,10]]}}}