Lower-limb orthopedic surgery encompasses fracture fixation, joint replacement, and other procedures with different requirements for positioning, operative duration, and postoperative rehabilitation. Anesthetic management contributes to the perioperative experience through its effects on consciousness, nociception, cardiovascular function, and early recovery. Spinal and general anesthesia are both established options, but their relative value depends on the patient and operation. A systematic review of comparative studies in hip and knee arthroplasty found a modest reduction in hospital stay with neuraxial anesthesia, while evidence for several major outcomes remained limited. This supports evaluating individual outcomes rather than assuming that one technique offers a uniform advantage.[1] Neuraxial anesthesia interrupts sensory and sympathetic transmission, permitting surgery without routine airway instrumentation. General anesthesia provides unconsciousness and facilitates controlled ventilation when required. Both approaches can be combined with additional analgesic strategies. Their effects therefore depend partly on associated sedation, systemic opioids, nerve blocks, and institutional recovery practices. The International Consensus on Anaesthesia-Related Outcomes after Surgery recommendations favored neuraxial anesthesia for primary arthroplasty when appropriate, drawing on a large evidence base that included observational studies. However, those recommendations require interpretation in relation to procedure type, contraindications, and the certainty of the underlying evidence.[2] Randomized evidence has qualified expectations derived from routine clinical datasets. In the REGAIN trial, spinal anesthesia did not improve the composite outcome of death or inability to walk independently at 60 days compared with general anesthesia among older adults undergoing hip-fracture surgery.[3] The RAGA trial likewise found no significant reduction in postoperative delirium with regional anesthesia without sedation.[4] These findings address clinically important endpoints, although their applicability to a younger population undergoing mixed lower-limb procedures is incomplete. An earlier Cochrane review also identified limitations in the certainty of evidence comparing anesthetic approaches for hip-fracture surgery.[5] Early postoperative pain, nausea, urinary retention, and hemodynamic events remain relevant even when major functional outcomes are similar. Sympathetic blockade during spinal anesthesia can produce arterial and venous dilation, reducing blood pressure and occasionally accompanying bradycardia.[6] Conversely, analgesic and antiemetic practices influence recovery after either technique. Retrospective institutional comparisons can describe these patterns within everyday care, provided that differences in case selection, documentation, and co-interventions are acknowledged. Local data are particularly useful when interpreted as associations and supported by transparent definitions and complete records. The objective of this study was to compare perioperative outcomes between spinal and general anesthesia for lower-limb orthopedic surgery at RVM Institute of Medical Sciences and Research Center during August 2025–July 2026. Specific objectives were to describe baseline characteristics, surgical duration, blood loss, fluid administration, hypotension, bradycardia, vasopressor use, transfusion, early postoperative pain, rescue analgesia, adverse events, and hospital stay.

Study design and setting A retrospective comparative design was specified for lower-limb orthopedic surgery at RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India. The study period was August 2025–July 2026. Reporting should follow the Strengthening the Reporting of Observational Studies in Epidemiology framework and the RECORD guidance for routinely collected health data.[7,8] The study contains 50 patients, with 25 in each anesthesia group. Participants and record selection The study population comprised patients undergoing fracture fixation, joint arthroplasty, or other lower-limb orthopedic surgical procedures during the specified study period. Eligible cases were identified from operating-theater registers and cross-referenced with anesthesia records, post-anesthesia care unit records, and inpatient medical files to ensure completeness of perioperative information. Patients meeting the predefined age and eligibility criteria and having complete records containing the variables required for analysis were included. Records with incomplete or unavailable perioperative data, procedures outside the defined lower-limb orthopedic scope, and repeat operations involving the same patient during the study period were excluded as applicable. For patients with more than one eligible procedure, only the first qualifying operation was considered to avoid duplication of observations. A total of 50 patient records were included in the final analysis, with 25 patients receiving spinal anesthesia and 25 receiving general anesthesia. The anesthesia technique was determined from the documented clinical record and was not assigned by the investigators. Therefore, the equal group sizes should not be interpreted as evidence of random allocation or matching. Records were selected according to the predefined eligibility criteria and availability of complete data for the study variables. The final sample size of 50 represented the eligible records available for analysis during the defined study period and was considered appropriate for this retrospective comparative evaluation. Anesthesia exposure and baseline variables Patients are categorized according to the anesthesia technique documented for the index operation. Record extraction should include age, sex, body mass index, ASA physical status, hypertension, diabetes, surgical urgency, and procedure category. Outcome assessment The prespecified comparison covers operative duration, estimated blood loss, intravenous fluid volume, hypotension, bradycardia, vasopressor administration, and intraoperative transfusion. Postoperative variables include pain scores on a 0–10 scale at two and six hours, time to first rescue analgesia, opioid administration within 24 hours, nausea or vomiting within 24 hours, urinary retention, shivering, and hospital stay. statistical analysis Continuous variables are presented as mean ± standard deviation and categorical variables as frequencies and percentages. Ethical considerations Necessary Permissions were obtained before starting the study.

The study comprised 50 patients: 25 received spinal anesthesia and 25 received general anesthesia. Mean age was 49.8 ± 13.6 and 51.2 ± 14.1 years, respectively. Men accounted for 60% of the spinal group and 64% of the general group. ASA physical status II predominated in both groups. Fracture fixation was the most frequent procedure, representing 64% and 68% of operations. Baseline demographic and clinical characteristics are presented in Table 1. Table 1. Baseline characteristics according to anesthesia technique Characteristic Spinal anesthesia (n = 25) General anesthesia (n = 25) Age, years 49.8 ± 13.6 51.2 ± 14.1 Male sex 15 (60%) 16 (64%) Female sex 10 (40%) 9 (36%) Body mass index, kg/m² 25.1 ± 3.4 25.6 ± 3.8 ASA physical status I 8 (32%) 7 (28%) ASA physical status II 13 (52%) 14 (56%) ASA physical status III 4 (16%) 4 (16%) Hypertension 7 (28%) 8 (32%) Diabetes mellitus 5 (20%) 6 (24%) Elective surgery 18 (72%) 17 (68%) Emergency surgery 7 (28%) 8 (32%) Fracture fixation 16 (64%) 17 (68%) Joint arthroplasty 6 (24%) 5 (20%) Other lower-limb procedures 3 (12%) 3 (12%) Note. N = 50. Values are mean ± standard deviation or n (%). ASA: American Society of Anesthesiologists. Percentages use the corresponding group denominator of 25. Mean operative duration was 94.6 ± 24.8 minutes with spinal anesthesia and 99.2 ± 27.3 minutes with general anesthesia. Estimated blood loss averaged 182 ± 76 and 224 ± 91 mL, respectively. Hypotension and vasopressor administration were each recorded in seven patients (28%) in the spinal group and four patients (16%) in the general group. Bradycardia occurred in three patients (12%) and one patient (4%), while transfusion was recorded in one patient (4%) and two patients (8%), respectively. Intraoperative outcomes are summarized in Table 2. Table 2. Intraoperative outcomes according to anesthesia technique Outcome Spinal anesthesia (n = 25) General anesthesia (n = 25) Duration of surgery, minutes 94.6 ± 24.8 99.2 ± 27.3 Estimated blood loss, mL 182 ± 76 224 ± 91 Intravenous fluid administration, mL 1,180 ± 310 1,260 ± 340 Hypotension 7 (28%) 4 (16%) Bradycardia 3 (12%) 1 (4%) Vasopressor administration 7 (28%) 4 (16%) Intraoperative blood transfusion 1 (4%) 2 (8%) Note. Values are mean ± standard deviation or n (%). Hypotension and bradycardia definitions require confirmation against the actual protocol and records. Pain scores at two hours were 2.1 ± 1.0 following spinal anesthesia and 4.3 ± 1.4 following general anesthesia; corresponding six-hour scores were 3.4 ± 1.2 and 4.6 ± 1.3. Time to first rescue analgesia averaged 4.8 ± 1.6 versus 1.9 ± 0.8 hours. Opioid administration within 24 hours was recorded in nine patients (36%) versus 17 patients (68%). Postoperative nausea or vomiting occurred in three patients (12%) versus eight patients (32%), whereas urinary retention affected four patients (16%) versus one patient (4%). Mean hospital stay was 4.6 ± 1.3 versus 5.2 ± 1.6 days. Postoperative findings are presented in Table 3. Table 3. Postoperative outcomes according to anesthesia technique Outcome Spinal anesthesia (n = 25) General anesthesia (n = 25) Pain score at 2 hours, 0–10 scale 2.1 ± 1.0 4.3 ± 1.4 Pain score at 6 hours, 0–10 scale 3.4 ± 1.2 4.6 ± 1.3 Time to first rescue analgesia, hours 4.8 ± 1.6 1.9 ± 0.8 Rescue opioid administration within 24 hours 9 (36%) 17 (68%) Nausea or vomiting within 24 hours 3 (12%) 8 (32%) Urinary retention 4 (16%) 1 (4%) Postoperative shivering 5 (20%) 3 (12%) Hospital stay, days 4.6 ± 1.3 5.2 ± 1.6 Note. Values are mean ± standard deviation or n (%). Assessment definitions and time origins require confirmation.

The study indicates differences in early recovery between anesthesia groups, with lower pain scores, less rescue opioid administration, and fewer nausea or vomiting episodes following spinal anesthesia. Hypotension, bradycardia, and urinary retention were more frequent in that group. Because the values remain unverified and the comparison is descriptive, these patterns cannot be treated as demonstrated treatment effects. Similar baseline averages also do not exclude meaningful imbalance in fracture severity, operative complexity, comorbidity, or clinical reasons for selecting anesthesia. The two-hour pain-score difference was 2.2 points, and first rescue analgesia occurred 2.9 hours later with spinal anesthesia. Residual sensory blockade offers a plausible explanation, but the spinal agent, intrathecal adjuvants, and accompanying analgesic regimens were not provided. Importantly, a secondary randomized REGAIN analysis found greater worst pain during the first postoperative day with spinal anesthesia, with a mean difference of 0.40 points, and no difference at several later assessments.[9] That endpoint differs from pain measured specifically at two hours. The comparison emphasizes why assessment timing and procedure mix must be considered before extrapolating analgesic benefit. Nausea or vomiting affected 12% of the spinal group and 32% of the general group. Interpretation requires information on volatile anesthetics, systemic opioid exposure, previous nausea, and prophylactic antiemetics. Consensus guidance identifies modifiable anesthetic exposures and recommends risk-based prevention, supporting assessment of these factors rather than attribution to technique alone.[10] Hypotension affected 28% versus 16%; sympathetic blockade provides a physiological explanation consistent with the review by Ferré and colleagues.[6] Urinary retention, recorded in 16% versus 4%, also deserves attention. A prospective arthroplasty study associated spinal anesthesia with catheterization-defined retention, although bladder-management thresholds and patient characteristics influence reported frequencies.[11] Estimated blood loss was 42 mL lower and hospital stay 0.6 days shorter in the spinal group. Johnson and colleagues reported a pooled reduction in arthroplasty stay of approximately 0.40 days, offering a contextual comparison rather than direct validation.[1] Conversely, Weinstein and colleagues found longer stay with spinal anesthesia in a propensity-matched hip-fracture cohort despite associations favoring spinal anesthesia for major complications.[12] Differences in rehabilitation, discharge planning, and procedure selection can explain divergent hospitalization findings. Long-term REGAIN follow-up found similar survival and functional outcomes with spinal and general anesthesia.[13] A 2025 meta-analysis of 41 retrospective arthroplasty studies reported favorable associations for spinal anesthesia, but its observational evidence remains susceptible to residual confounding.[14] Together, these sources support individualized anesthesia selection and careful separation of early symptom control from longer-term outcomes

The study of 50 lower-limb orthopedic procedures indicates lower early postoperative pain scores, longer time to rescue analgesia, less opioid administration, and fewer nausea or vomiting episodes with spinal anesthesia. Hypotension and urinary retention were more frequent. Blood loss and hospital stay were numerically lower, although descriptive differences establish neither statistical significance nor causation. Anesthesia selection should consider patient characteristics, operative requirements, and perioperative care.

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