European Journal of Cardiovascular Medicine

Anaesthesia plays a pivotal role in determining surgical outcomes, postoperative recovery, and overall patient satisfaction. Among the various anaesthetic modalities, general anaesthesia (GA) and regional anaesthesia (RA) are commonly employed in general surgical procedures. While GA induces a reversible loss of consciousness and systemic analgesia, RA involves targeted nerve blockade, allowing the patient to remain conscious while providing localized pain relief [1].

The selection between GA and RA is influenced by surgical type, patient comorbidities, and institutional protocols. However, growing evidence indicates that the anaesthetic technique used may have a profound impact on key postoperative parameters, including pain control, incidence of postoperative nausea and vomiting (PONV), time to ambulation, hospital stay, and complication rates. Regional anaesthesia, in particular, has been associated with reduced opioid consumption, improved pain scores, and enhanced early recovery—benefits that are consistent with the objectives of Enhanced Recovery After Surgery (ERAS) protocols [2–4].

For example, Elkassabany et al. demonstrated that a multimodal perioperative pain management approach, including regional techniques, significantly improved recovery quality in ambulatory shoulder surgery patients [4]. Similarly, Bosco et al. showed that the use of interscalene blocks in shoulder arthroscopy reduced perioperative morbidity and contributed to better recovery outcomes [5].

Despite such evidence, comparative data on GA versus RA in the context of elective general surgery—especially in resource-limited, real-world clinical settings—remain limited. Therefore, understanding the differential impact of anaesthetic techniques on postoperative recovery can assist clinicians in optimizing perioperative care and improving patient outcomes [1–5].

This study was therefore conducted to assess and compare the impact of general versus regional anaesthesia on postoperative recovery among patients undergoing general surgical procedures. The findings are expected to contribute to anaesthesia strategy optimization and improved quality of surgical care.

Study Design and Setting

This was a prospective observational study conducted in the Department of Anaesthesiology at Government Medical College (GMC), Wanaparthy, over a period of eleven months from March 2024 to January 2025.

Study Population

The study included 100 adult patients aged between 18 and 65 years who were scheduled to undergo elective general surgical procedures under either general or regional anaesthesia. Patients were recruited using a consecutive sampling method until the desired sample size was achieved. All patients provided written informed consent prior to enrolment.

Inclusion Criteria

Patients aged 18–65 years

ASA physical status I or II

Elective general surgical cases (e.g., hernia repair, appendectomy, cholecystectomy)

Exclusion Criteria

Emergency surgeries

ASA physical status III or above

Known allergy to anaesthetic agents

Patients with psychiatric disorders, cognitive impairment, or communication difficulties

Refusal to participate

Grouping and Anaesthetic Techniques

Patients were grouped based on the anaesthetic technique administered:

Group A (General Anaesthesia, GA): Received standard general anaesthesia with intravenous induction and inhalational maintenance.

Group B (Regional Anaesthesia, RA): Received either spinal or epidural anaesthesia, based on surgical requirement and anaesthesiologist discretion.

The choice of anaesthesia was made by the attending anaesthesiologist according to clinical judgment, patient suitability, and surgeon’s preference. No randomisation or intervention was performed by the investigators.

Data Collection

Data were collected using a structured case record form. The following parameters were recorded:

Demographic data: Age, sex, ASA physical status

Postoperative parameters:

Time to first analgesic requirement (in hours)

Incidence of postoperative nausea and vomiting (PONV)

Pain score using the Visual Analogue Scale (VAS) at 6 hours

Time to first ambulation (in hours)

Length of hospital stay (in days)

Occurrence of postoperative complications

Patient satisfaction score (0–10 scale)

Outcome Measures

The primary outcome was the comparison of postoperative recovery profiles between the two anaesthesia groups, including pain scores, analgesic requirements, ambulation time, and complications. Secondary outcomes included patient satisfaction and hospital stay duration.

Statistical Analysis

Data were entered in Microsoft Excel and analyzed using SPSS version 25.0. Continuous variables were expressed as mean ± standard deviation (SD) and compared using the Student’s t-test. Categorical variables were presented as frequencies and percentages and analyzed using the Chi-square test or Fisher’s exact test as appropriate. A p-value of < 0.05 was considered statistically significant.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of GMC Wanaparthy. Confidentiality and anonymity of the participants were strictly maintained throughout the study.

A total of 100 patients undergoing elective general surgical procedures were enrolled in the study and were equally divided into two groups: Group A received general anaesthesia (n=50), and Group B received regional anaesthesia (n=50).

Demographic Characteristics

The mean age of the study population was 42.5 ± 12.8 years, with a male predominance (58%). There was no statistically significant difference in the baseline demographic characteristics between the two groups. The distribution of ASA physical status was similar, with the majority being ASA Class I (60%) and the remainder ASA Class II (40%) (Table 1).

Postoperative Recovery Outcomes

Significant differences were observed in postoperative recovery profiles between the two anaesthetic techniques. The mean time to first analgesic requirement was significantly longer in Group B (4.5 ± 1.1 hours) compared to Group A (2.1 ± 0.6 hours), indicating prolonged analgesia with regional techniques (p < 0.001). The incidence of postoperative nausea and vomiting (PONV) was also notably lower in the regional anaesthesia group (20%) versus the general anaesthesia group (64%) (p < 0.001).

Table 1: Demographic Profile of Study Population

In terms of pain scores, Group B patients reported significantly lower Visual Analogue Scale (VAS) scores at 6 hours postoperatively (3.9 ± 1.1) compared to Group A (6.2 ± 1.4) (p < 0.001). Additionally, time to ambulation was earlier in the regional anaesthesia group (12.6 ± 3.9 hours vs. 18.4 ± 4.3 hours, p < 0.001), and mean hospital stay was shorter (3.1 ± 1.2 days vs. 4.2 ± 1.5 days, p = 0.002). Postoperative complications were fewer in the regional group (8%) compared to the general group (20%) (p = 0.048) (Table 2).

Table 2: Postoperative Recovery Parameters

Patient Satisfaction

Patient satisfaction scores were significantly higher among those who received regional anaesthesia (mean score 8.7 ± 1.1) than those who received general anaesthesia (6.9 ± 1.4), with a p-value of < 0.001, indicating a higher level of perceived comfort and overall satisfaction in the regional group (Table 3).

Table 3: Patient Satisfaction Scores

This prospective observational study evaluated the impact of anaesthetic technique—general anaesthesia (GA) versus regional anaesthesia (RA)—on postoperative recovery in patients undergoing elective general surgery. The findings clearly indicate that regional anaesthesia is associated with significantly better outcomes in terms of postoperative pain control, early ambulation, reduced postoperative nausea and vomiting (PONV), shorter hospital stay, and higher patient satisfaction.

The prolonged time to first analgesic requirement observed in the RA group (4.5 ± 1.1 hours) compared to the GA group (2.1 ± 0.6 hours) highlights the superior analgesic efficacy of regional techniques. This is supported by previous research demonstrating that neuraxial or peripheral nerve blocks provide extended pain relief and reduce the need for systemic opioids in the early postoperative period [6,7].

The markedly lower incidence of PONV in the RA group (20%) versus the GA group (64%) reinforces the established association between volatile anaesthetics and PONV. RA techniques reduce the need for emetogenic agents and systemic opioids, thereby minimizing gastrointestinal side effects and contributing to patient comfort [9]. This reduction in PONV is particularly significant, as it is a major cause of postoperative dissatisfaction and can delay recovery.

Pain scores, assessed using the Visual Analogue Scale (VAS) at 6 hours, were significantly lower in patients who received RA, demonstrating the efficacy of regional blocks in attenuating nociceptive input. These findings are consistent with reports from Catro-Alves et al. and others who showed improved pain control and quality of recovery with regional techniques, particularly in abdominal and orthopaedic surgeries [7,9].

Earlier ambulation in the RA group (12.6 ± 3.9 hours vs. 18.4 ± 4.3 hours) is likely a consequence of better pain relief and reduced sedative exposure. Early mobilization is a well-established predictor of reduced thromboembolic complications and enhanced functional recovery [10,11].

Length of hospital stay was significantly shorter in the RA group (3.1 ± 1.2 days) compared to the GA group (4.2 ± 1.5 days), consistent with ERAS goals and previous findings in gynaecological and orthopaedic surgeries [10]. Efficient pain control, fewer complications, and early mobilization collectively contribute to earlier discharge and reduced healthcare burden.

Notably, patient satisfaction was higher in the RA group, as reflected by a mean score of 8.7 ± 1.1 compared to 6.9 ± 1.4 in the GA group. This finding mirrors results from prior studies that used validated recovery scoring tools such as the QoR-40, which emphasize subjective patient-reported outcomes as key indicators of recovery quality [8].

While the results of this study are consistent with established literature, it is important to acknowledge limitations. The non-randomised design may introduce selection bias, and variations in surgical type or anaesthesiologist preference could affect recovery metrics. However, the real-world setting of the study enhances its generalizability to similar healthcare environments.

This prospective observational study demonstrates that regional anaesthesia offers significant advantages over general anaesthesia in enhancing postoperative recovery among general surgery patients. Patients who received regional anaesthesia experienced delayed need for analgesia, reduced incidence of postoperative nausea and vomiting, lower pain scores, earlier ambulation, shorter hospital stay, and higher satisfaction levels. These findings support the integration of regional anaesthesia into perioperative care pathways, particularly within Enhanced Recovery After Surgery (ERAS) protocols. While the observational nature of the study limits causal inference, the results strongly suggest that anaesthetic technique plays a pivotal role in optimizing postoperative outcomes. Further randomized studies are recommended to confirm these findings across broader surgical populations.

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