Background <p>The choice of anaesthetic technique has the potential to exert a significant influence on the perioperative stress response, immune modulation and inflammation which are critical factors in surgical recovery. The primary objective of this study was to compare 24-h postoperative IL-6 levels between patients undergoing lumbar microdiscectomy under TIVA or sevoflurane anesthesia. Secondary outcomes included perioperative changes in CRP, NLR and PLR.</p> Methods <p>This prospective, randomised, double-blind study included 40 patients classified as American Society of Anesthesiologists (ASA) I-II and scheduled for elective lumbar disc herniation surgery. Patients were randomly assigned to receive either TIVA with propofol or inhalational anaesthesia with sevoflurane. Interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR) levels were measured at preoperative, intraoperative and postoperative time points.</p> Results <p>Postoperative IL-6 levels were significantly lower in the TIVA group than in the sevoflurane group (<i>p</i> &lt; 0.05), with a blunted increase in IL-6 levels from the preoperative to the postoperative phases. Postoperative CRP levels were significantly lower in the TIVA group (<i>p</i> &lt; 0.05), whereas PCT levels remained stable across groups. There were no significant differences between groups in NLR values.</p> Conclusion <p>The results of this study indicate that TIVA with propofol may offer a superior modulation of inflammatory responses compared to sevoflurane in patients undergoing lumbar microdiscectomy. These findings indicate that TIVA may be a preferred anaesthetic technique for surgical procedures that require precise control of the perioperative inflammatory response. Further studies are required to validate these findings in larger populations and diverse surgical contexts.</p> Trial registration <p>ClinicalTrials.gov, NCT 06386965.</p>