Comparison of combined spinal-epidural versus general anesthesia with epidural catheter on postoperative quality of recovery after abdominal hysterectomy: a prospective observational study.

BACKGROUND

We aimed to evaluate the effect of combined spinal-epidural (CSE) anesthesia versus general anesthesia with an epidural catheter (GE) on the quality of postoperative recovery in abdominal hysterectomy patients. The recovery outcomes were assessed using the Quality of Recovery-15 (QoR-15) scale.

METHODS

This prospective, single-center observational study included 87 female patients (aged 18-75 years). Their ASA physical status varied from I to III, and they had a planned elective abdominal hysterectomy scheduled. We divided them into two groups based on the type of anesthesia administered: the CSE group and the GE group. The primary outcome consisted of the total QoR-15 score we measured 24 h after the operation. Among the secondary outcomes were the incidence of postoperative nausea and vomiting (PONV), analgesic consumption, pain scores assessed using the Numerical Rating Scale (NRS), the need for rescue analgesia, time to mobilization, hospitalization duration and the surgeon satisfaction score.

RESULTS

At 24 h post-surgery, the CSE group had a significantly higher QoR-15 score compared to that of the GE group, with scores of 131.97 ± 8.67 and 122.93 ± 13.41, respectively (p = 0.001). Additionally, the CSE group required less analgesic consumption, averaging 119.53 ± 33.16 ml compared to 149.32 ± 53.11 ml in the GE group (p = 0.002). The need for rescue analgesia was also lower in the CSE group, with 9.30% of patients requiring it compared to 27.27% in the GE group (p = 0.031). Furthermore, pain scores measured using the NRS and the PONV incidence were significantly lower in the CSE group during the first three hours after surgery (p < 0.001). However, there were no significant differences in the time to mobilization, length of hospital stays, or surgeon satisfaction scores between both groups.

CONCLUSION

Combined spinal-epidural anesthesia provides a better quality of postoperative recovery for patients undergoing abdominal hysterectomy. This technique improves pain control, reduces the need for opioids, and minimizes nausea and vomiting. These findings suggest that combined spinal-epidural anesthesia may enhance patient comfort and well-being during recovery.