Combined epidural-general anesthesia reduces opioid use and improves recovery after laparoscopic hysterectomy: a retrospective cohort study.

backgroundDespite enhanced recovery after surgery (ERAS) pathways, laparoscopic hysterectomy is still associated with substantial acute postoperative pain, opioid exposure, and postoperative nausea and vomiting (PONV). Neuraxial techniques may provide opioid-sparing analgesia, but evidence for combined epidural and general anesthesia in laparoscopic hysterectomy remains limited.

methodsThis single-center retrospective cohort study included consecutive women undergoing elective laparoscopic hysterectomy for benign uterine disease between April 2021 and September 2023. Patients received general anesthesia alone (GA) or combined epidural and general anesthesia (CEA + GA) according to routine practice, and all were managed within an institutional ERAS pathway. Outcomes included intraoperative fentanyl and propofol doses, postoperative 0–24 h opioid use (intravenous morphine equivalents, ME), total perioperative opioid consumption, time to recovery from anesthesia, Visual Analog Scale (VAS) pain scores at 6, 12, 24, and 48 h, time to first ambulation and flatus, length of stay, hemodynamic variables, and anesthesia-related adverse events including PONV. Serum prostaglandin E2, 5-hydroxytryptamine, and substance P were measured from pre-induction to 48 h postoperatively. Multivariable linear regression assessed factors associated with total perioperative opioid dose, and logistic regression evaluated factors associated with PONV.

resultsNinety-eight patients were included (GA, n = 42; CEA + GA, n = 56), with comparable baseline characteristics. Compared with GA, CEA + GA was associated with lower intraoperative fentanyl and propofol requirements, reduced total perioperative opioid consumption, lower VAS scores during the first 24 h, fewer rescue analgesia requirements, shorter time to recovery from anesthesia, earlier ambulation and bowel recovery, and a shorter hospital stay. Hemodynamic parameters were more stable, and intraoperative and early postoperative adverse events, including PONV, were less frequent with CEA + GA. In multivariable analyses, CEA + GA remained independently associated with reduced total perioperative opioid dose, and higher opioid exposure was independently associated with increased odds of PONV.

conclusionsIn women undergoing laparoscopic hysterectomy within an ERAS pathway, combined epidural and general anesthesia was associated with lower opioid exposure, improved early pain control, greater hemodynamic stability, and fewer anesthesia-related adverse events compared with general anesthesia alone. This approach may be a useful opioid-sparing anesthetic option to enhance perioperative recovery after laparoscopic hysterectomy.