In the realm of modern surgical practice, anesthesia plays a critical role in determining intraoperative stability and postoperative recovery. The choice between general anesthesia (GA) and regional anesthesia (RA) for elective abdominal surgeries has long been a subject of clinical debate, particularly in relation to patient safety, postoperative complications, and recovery trajectories [1]. General anesthesia induces a reversible state of unconsciousness and systemic analgesia, allowing for extensive surgical manipulation. However, it is also associated with risks such as respiratory depression, postoperative nausea and vomiting, and delayed recovery of bowel function [2]. In contrast, regional anesthesia, which includes spinal, epidural, or peripheral nerve blocks, provides targeted sensory and motor blockade without loss of consciousness, offering several physiological and clinical benefits [3]. Several studies have suggested that RA may reduce perioperative morbidity by preserving respiratory mechanics, minimizing systemic drug exposure, and enhancing postoperative analgesia [4]. For abdominal procedures, especially in high-risk patients or the elderly, regional techniques may lower the incidence of thromboembolic events, respiratory complications, and cardiovascular stress. Moreover, regional anesthesia is often linked to shorter hospital stays and faster mobilization, both of which align with enhanced recovery after surgery (ERAS) protocols that emphasize early return to baseline function [5]. General anesthesia provides complete unconsciousness and amnesia, facilitating optimal surgical conditions [6]. It is often favored for procedures requiring muscle relaxation, airway control, or prolonged duration. However, GA is associated with various systemic effects, including suppression of respiratory drive, potential cardiovascular depression, and a heightened inflammatory response, which may contribute to complications such as postoperative cognitive dysfunction, pulmonary complications, ileus, and delayed return of bowel function [7]. Additionally, postoperative nausea and vomiting (PONV), sore throat, and longer recovery room stays are more frequently reported in GA cases, especially when volatile anesthetics or opioids are used [8].

On the other hand, regional anesthesia, comprising spinal, epidural, or combined spinal-epidural techniques offers an alternative with numerous advantages in select populations. RA techniques provide effective intraoperative analgesia and prolonged postoperative pain relief without the need for systemic sedation or opioid administration. This minimizes opioid-related side effects and supports faster recovery milestones such as early ambulation, resumption of oral intake, and discharge readiness [9]. Regional anesthesia has also been linked with reduced rates of deep vein thrombosis, pulmonary embolism, and acute postoperative delirium, particularly in elderly or comorbid patients. Moreover, from a physiological perspective, RA attenuates the neuroendocrine stress response to surgery by blocking afferent nociceptive transmission, which may contribute to lower cortisol and catecholamine levels perioperatively [10]. These effects are particularly valuable in high-risk patients, such as those with ischemic heart disease, chronic obstructive pulmonary disease, or diabetes, for whom the surgical stress response can precipitate significant complications [11]. Despite numerous studies comparing GA and RA in various surgical populations, the evidence remains inconclusive due to heterogeneity in patient selection, surgical type, outcome measures, and institutional practices. In the context of elective abdominal surgeries such as hernia repairs, cholecystectomies, or colorectal procedures the choice of anesthesia should ideally be guided by anticipated benefits in postoperative pain control, complication reduction, and enhanced recovery [12].

Objective

To compare the effects of general versus regional anesthesia on postoperative outcomes, including pain scores, complication rates, and hospital stay duration in elective abdominal surgeries.

This was a prospective comparative observational study that enrolled total of 246 adult patients scheduled for elective abdominal surgeries after obtaining written informed consent. These patients were divided into two groups based on the anesthetic technique used: Group A (n=123) received general anesthesia (GA), and Group B (n=123) underwent regional anesthesia (RA), including spinal or epidural blocks, depending on the surgical and anesthetic indication.

Inclusion Criteria

Patients aged 18 to 70 years undergoing planned abdominal surgeries, classified as American Society of Anesthesiologists (ASA) physical status I–III, were included. Only those with elective, non-emergency procedures were selected to ensure homogeneity of outcomes.

Exclusion Criteria

Patients with coagulopathies, infection at the site of spinal injection, known hypersensitivity to local anesthetics, ASA class IV and above, pregnancy, and those who required conversion of anesthesia modality intraoperatively were excluded.

Data Collection

Demographic data, comorbid conditions, surgical duration, type of procedure, and anesthesia modality were recorded. Postoperative outcomes were monitored and included time to first ambulation, pain scores (VAS scale), time to return of bowel sounds, need for opioid analgesia, nausea and vomiting incidence, and duration of hospital stay. Pain was assessed using the Visual Analog Scale (VAS) at fixed postoperative intervals: 2 hours, 6 hours, 12 hours, and 24 hours. Complications such as ileus, urinary retention, hypotension, and wound infection were noted. Postoperative recovery was gauged by the ability to ambulate, tolerance of oral intake, and readiness for discharge as per institutional ERAS protocol criteria.

Statistical Analysis

Data were entered into SPSS version 17. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables were presented as frequencies and percentages. Independent t-tests were used for comparison of means, while chi-square tests were employed for categorical variables. A p-value < 0.05 was considered statistically significant.

The mean age was slightly higher in the regional group (52.1 ± 11.9 years) compared to the general group (49.8 ± 12.6 years), though this difference was not statistically significant (p = 0.08). Gender distribution was similar across both groups, with males comprising 59.1% in the general and 56.1% in the regional group (p = 0.66). Comorbidities such as hypertension and diabetes mellitus were also evenly distributed between the two groups (p = 0.85 and p = 0.87, respectively). Smoking history showed a non-significant trend towards higher prevalence in the general anesthesia group (31.1% vs. 24.6%, p = 0.25).

Table 1: Baseline Demographic and Clinical Characteristics (n = 246)

The average hospital stay was notably shorter in the regional group (4.1 ± 1.5 days) compared to the general group (5.4 ± 1.7 days; p < 0.001). Similarly, postoperative pain scores were significantly lower in the regional group (VAS 4.5 ± 1.1) versus the general group (VAS 6.3 ± 1.2; p < 0.001). Incidence of nausea and vomiting was also significantly reduced (14.9% vs. 29.5%; p = 0.007). While fewer patients required ICU admission in the regional group (8.8% vs. 16.7%; p = 0.05), the rate of wound infection showed no significant difference between groups (p = 0.32).

Table 2: Postoperative Outcomes by Anesthesia Type

This study aimed to evaluate and compare postoperative outcomes among patients undergoing elective abdominal surgeries under general versus regional anesthesia. The findings demonstrate a clear trend toward improved short-term postoperative outcomes in patients who received regional anesthesia. These benefits included significantly reduced hospital stay, lower postoperative pain scores, and fewer anesthesia-related complications such as nausea and vomiting [13]. The shorter mean hospital stay observed in the regional anesthesia group (4.1 vs. 5.4 days) is consistent with prior literature suggesting that regional techniques may promote faster mobilization, fewer systemic drug effects, and earlier return to baseline function. This reduction not only reflects improved patient recovery but may also contribute to lower healthcare costs [14]. Similarly, the significantly lower VAS pain scores highlight the superior analgesic control associated with regional techniques, which can reduce the need for systemic opioids and their associated side effects. Nausea and vomiting were also less frequently reported in the regional anesthesia group. This is expected, as general anesthesia often requires volatile agents and opioids both known contributors to postoperative nausea and vomiting (PONV) [15] [16]. The lower incidence of PONV contributes to improved patient satisfaction and reduced delay in oral intake and mobilization. ICU admissions were notably higher in the general anesthesia group. While the reasons are multifactorial, general anesthesia may exacerbate comorbidities or lead to hemodynamic instability, particularly in older or higher-risk patients [17]. Although not statistically significant, the wound infection rate was also higher in the general anesthesia group, which may reflect longer hospital stays, delayed ambulation, or immune-modulatory effects of systemic anesthesia drugs. It is important to note that while regional anesthesia demonstrated better outcomes overall, its application is not always feasible. Contraindications such as coagulopathy, patient refusal, or technical difficulty may limit its use. Moreover, surgical type, duration, and institutional preferences can also influence anesthesia choice.

It is concluded that regional anesthesia is associated with more favorable postoperative outcomes compared to general anesthesia in patients undergoing elective abdominal surgery. Specifically, patients receiving regional anesthesia experienced shorter hospital stays, lower postoperative pain scores, and a reduced incidence of anesthesia-related complications such as nausea, vomiting, and ICU admissions.

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