Search Results (166)

Background/Objectives: Intraoperative oliguria has long been considered a marker of impaired renal perfusion, but its prognostic value for postoperative acute kidney injury (AKI) remains controversial, particularly within Enhanced Recovery After Surgery (ERAS) protocols. We investigated the association between intraoperative oliguria and postoperative AKI in patients undergoing major hepatobiliary and pancreatic surgery within an ERAS protocol. Methods: Patients who underwent major hepatobiliary and pancreatic surgery within an institutional ERAS protocol were retrospectively analyzed. Intraoperative oliguria was defined as urine output < 0.3 mL kg⁻¹ h⁻¹. Postoperative AKI was defined according to the KDIGO serum creatinine criterion within 7 days after surgery. The association was assessed using multivariable logistic regression and sensitivity analyses were performed using an alternative oliguria threshold of <0.5 mL kg⁻¹ h⁻¹ and incorporating additional surgical covariates. Results: Among 816 patients, intraoperative oliguria occurred in 51 (6.3%), and postoperative AKI developed in 60 (7.4%). AKI incidence did not differ between the oliguria and non-oliguria groups (11.8% vs. 7.1%, p = 0.332), and median intraoperative urine output was comparable between the AKI and non-AKI groups (0.7 [0.5–1.1] vs. 0.8 [0.6–1.4] mL kg⁻¹ h⁻¹, p = 0.069). In multivariable analysis, intraoperative oliguria was not independently associated with AKI (OR 1.68, 95% CI 0.60–4.01; p = 0.276). Oral carbohydrate loading, thoracic epidural analgesia, and total intraoperative fluid volume were not associated with AKI. Results were consistent across both sensitivity analyses. Conclusions: In patients undergoing hepatobiliary and pancreatic surgery within the ERAS protocol, intraoperative oliguria was not associated with postoperative AKI, although modest association cannot be excluded given the limited number of AKI and oliguria events. These findings suggest that intraoperative urine output alone may not be a reliable indication for additional fluid administration, and larger prospective studies are needed to confirm this. Full article

For perioperative analgesia in thoracic surgery, epidural anesthesia has long been considered the gold standard. However, as surgical techniques have become less invasive, interest in less invasive analgesic strategies has increased. According to the procedure-specific postoperative pain management (PROSPECT) guidelines published by the European Society of Regional Anesthesia in 2021, epidural anesthesia is no longer recommended as the method of choice for regional anesthesia in video-assisted thoracic surgery (VATS), and thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) are now recommended. Understanding the effectiveness and limitations of each regional technique is essential to facilitating appropriate anesthetic planning for individual cases. This narrative review summarizes current evidence regarding thoracic epidural anesthesia, TPVB, ESPB, serratus anterior plane block, and emerging intertransverse process block techniques for thoracic surgery. Full article

Introduction: Labor pain is among the most intense forms of acute pain, mediated in part by excitatory glutamatergic neurotransmission within central nociceptive pathways. Glutamate plays a key role in spinal dorsal horn signaling and central sensitization, yet its peripheral dynamics during labor and in response to different analgesic modalities remain unclear. This exploratory study aimed to evaluate whether maternal salivary glutamate levels differ between epidural labor analgesia and systemic morphine analgesia during normal vaginal delivery. Method: In this observational comparative study, 36 women were selected to either epidural analgesia (n = 16) or systemic morphine analgesia (n = 20). Salivary samples were collected during active labor and analyzed for glutamate concentration using a validated enzymatic colorimetric assay. Clinical and demographic data were recorded. Non-parametric tests were applied due to non-normal distribution of glutamate levels. Results: Baseline maternal and perinatal characteristics were comparable between groups. Median salivary glutamate levels were higher in the epidural group than in the morphine group (5.32 nmol/µL [IQR 2.83–8.00] vs. 3.99 nmol/µL [IQR 2.26–8.03]), but the difference was not statistically significant (p = 0.599). Glutamate concentrations showed marked inter-individual variability (0.14–29.89 nmol/µL) and a right-skewed distribution. No significant associations were observed between glutamate levels and maternal age, Body Mass Index, gestational age, birth weight, or obstetric comorbidities. Conclusion: In this exploratory cohort, maternal salivary glutamate concentrations did not differ significantly between epidural labor analgesia and systemic morphine analgesia during labor. The variability observed suggests complex and heterogeneous regulation of peripheral glutamatergic activity in parturition. Further larger-scale studies integrating central and peripheral measurements are warranted. Full article

Background/Objectives: major open abdominal surgery remains associated with clinically important postoperative pain, delayed gastrointestinal recovery, opioid exposure, and prolonged length of stay. Intravenous lidocaine infusion (IVLI) has biologically plausible analgesic, anti-hyperalgesic, anti-inflammatory, and opioid-sparing effects, but prior evidence syntheses have often combined open and minimally invasive procedures. This systematic review evaluated evidence for perioperative IVLI in adult patients undergoing major open abdominal surgery. Methods: the review was structured according to PRISMA 2020. The final search was run on 15 January 2026 and covered PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science Core Collection, ClinicalTrials.gov, and WHO ICTRP from database inception to that date, without language restrictions at the search stage. Eligible studies enrolled adults undergoing elective open abdominal surgery and compared systemic IVLI with placebo, usual care, or active epidural analgesic comparators. Primary outcomes were postoperative opioid consumption and pain intensity. Secondary outcomes included gastrointestinal recovery, postoperative ileus, length of hospital stay, postoperative nausea and vomiting, inflammatory/stress biomarkers, and adverse events. Results: ten randomized trials involving 658 participants were included. Placebo/usual-care trials and active-comparator trials were synthesized separately because they address different clinical questions. IVLI generally reduced opioid consumption compared with placebo, with extractable effects including a 55.9 mg reduction in 72 h morphine use in one abdominal surgery trial and a 13.9 mg reduction in 24 h morphine use after radical prostatectomy. Gastrointestinal recovery favored IVLI in most placebo-controlled studies; for example, first flatus occurred 12.5 h earlier and first bowel movement 28.4 h earlier in one trial. Active-comparator trials suggested comparable early dynamic pain outcomes versus thoracic epidural analgesia in selected settings, although opioid consumption findings were less consistent. No serious lidocaine-related toxicity was reported, but the included trials were underpowered to detect rare local anesthetic systemic toxicity events and did not consistently capture subclinical neurologic symptoms such as perioral numbness or visual disturbance. Conclusions: in adult open abdominal surgery, perioperative IVLI may provide opioid-sparing and recovery benefits, particularly when infusion continues beyond the intraoperative period. However, the certainty of evidence remains limited. Full article

Background: Epidural obstetric analgesia is the standard of care for labor pain relief; however, its impact on neonatal cerebral oximetry remains debated. Objective: We aimed to evaluate whether epidural analgesia modifies cerebral regional oxygen saturation (CrSO₂), measured by near-infrared spectroscopy (NIRS), in term neonates from low-risk deliveries. Methods: We conducted a prospective comparative observational cohort study, including 48 term newborns: 25 delivered under epidural analgesia (EA) and 23 without epidural analgesia (NE). CrSO₂ was monitored using NIRS (INVOS 5100C, Somanetics/Medtronic, Troy, MI, USA; OxyAlert NIRSensor Cerebral/Somatic Infant–Neonatal Sensor CNN/SNN) during the neonatal transition up to 15 min after birth (primary outcome), and its relationship with neonatal well-being parameters (umbilical cord pH, Apgar score, and other analytical and obstetric indicators) was explored. Results: Median CrSO₂ at 15 min was 79.52 [76.40–82.64] in the EA group and 78.65 [74.21–83.09] in the NE group. Both groups exhibited a similar temporal pattern characterized by a progressive increase, a peak at 10 min, and stabilization by 15 min. Mean (SD) CrSO₂ in EA/NE were: 2 min, 57.64 (14.8)/60.04 (14.4); 5 min, 79.56 (10.9)/79.39 (12.2); 10 min, 82.28 (8.1)/81.13 (9.7); 15 min, 79.52 (7.6)/78.65 (10.3). No significant between-group differences were detected at any time point using a linear mixed model (p-values: 2 min, 0.57; 5 min, 0.96; 10 min, 0.66; 15 min, 0.74). Conclusions: These findings indicate that epidural obstetric analgesia does not alter cerebral oximetry parameters in term neonates from low-risk deliveries during the early transitional period. Full article

Background/Objectives: Acute pancreatitis in pregnancy and the early postpartum period (APIP) is an uncommon but potentially life-threatening condition associated with significant maternal morbidity. Physiological adaptations of pregnancy, recent obstetric surgery, and overlapping postoperative symptoms frequently obscure early diagnosis and complicate perioperative and critical care management. This review provides a clinically oriented, anaesthesiology-focused overview of APIP, integrating current evidence with perioperative decision-making, pain management strategies, and intensive care considerations relevant to obstetric practice. Methods: A narrative, clinically structured review of the literature was performed focusing on epidemiology, aetiology, diagnosis, severity stratification, and management of APIP. Anaesthesiology- and ICU-specific aspects are synthesised into a pragmatic management framework. Results: Gallstone disease and hypertriglyceridaemia remain the predominant causes of APIP, with most cases occurring in the third trimester or early postpartum period. Diagnosis relies on pancreatic enzyme elevation and pregnancy-adapted imaging strategies. Early goal-directed fluid resuscitation, effective multimodal analgesia, and timely initiation of enteral nutrition are key determinants of outcome. Therapeutic ERCP and laparoscopic cholecystectomy can be safely performed during pregnancy when clinically indicated and may reduce recurrence in biliary pancreatitis. Neuraxial analgesia provides effective, opioid-sparing pain control and may improve respiratory mechanics and haemodynamic stability. Persistent organ failure remains the strongest predictor of adverse outcome and should prompt early intensive care admission. Conclusions: APIP requires early recognition and severity-adapted, multidisciplinary management. Anaesthesiology-led strategies play a central role in optimising analgesia, haemodynamic stability, and timely escalation of care. Framing APIP within a perioperative and critical care context may improve maternal outcomes in this vulnerable patient population. Full article

Background: Epidural procedures benefit from a pre-procedural informed estimation of epidural depth, as anticipating the approximate distance can support safer needle placement and reduce technical difficulties during analgesia or anesthesia procedures. The influence of ethnicity has been established across different populations worldwide; however, there is a lack of Saudi-specific MRI data on epidural depth among the adult population. Aim of this Study: To measure the skin to epidural space distance (SED) at the lumbar interspaces L3–L4 and L4–L5 in the Saudi adult population using magnetic resonance imaging (MRI) and to examine its correlations with age, sex, height, weight, and body mass index (BMI). Methods: In this retrospective cross-sectional study, sagittal T1-weighted lumbar MRI images of the spine of 169 adult Saudi patients were studied. The age group ranged from 20 to 70 years, with an equal distribution of males and females. The skin to epidural space distance (SED) was measured at the L3–L4 and L4–L5 interspaces, and its correlations with age, sex, height, weight, and BMI were analyzed. Results: The average measurement of skin to epidural space distance (SED) was 59.08 mm in L3–L4, and 63.21 in L4–L5. BMI and weight showed strong positive correlations with SED across both levels. Female sex was associated with longer SED values at L4–L5. There was no significant correlation between SED and age or height of the patients. Conclusions: MRI-based assessment of SED revealed strong correlations with weight and BMI, but no correlation with height, age, and sex. These findings support the individualized estimation of epidural depth and needle length selection to enhance procedural safety and reduce complications. Full article

Epidural catheters and epidural port systems are widely used in interventional pain management; however, infectious complications remain an important safety concern, particularly during prolonged catheterization. This retrospective real-world cohort study evaluated the incidence, microbiological characteristics, and time-dependent risk factors of epidural catheter- and port-related infections in a tertiary pain clinic. A total of 352 patients were included after predefined exclusion criteria were applied. Infection was defined based on clinical findings and microbiological confirmation. The overall infection rate was 10.5% (37/352). Catheter duration was significantly longer in patients who developed infection and remained an independent predictor in multivariable logistic regression analysis (odds ratio per day: 1.12; 95% CI: 1.06–1.19; p = 0.002). Receiver operating characteristic analysis demonstrated moderate discriminatory ability of catheter duration for predicting infection (AUC = 0.68), with an optimal cut-off of 7 days. The most frequently isolated pathogens were methicillin-resistant coagulase-negative staphylococci. No cases of meningitis or sepsis occurred, and all infections were successfully managed with antibiotic therapy. These findings emphasize the importance of duration-based risk assessment and careful follow-up strategies in patients requiring prolonged epidural analgesia. Full article

Background: Maternal control and the sense of support significantly influence a woman’s experience of birth. This study aimed to adapt and validate the Support and Control in Birth (SCIB) scale in Spanish women to assess maternal perceptions of support and control during birth, and to develop and validate an abbreviated version of the instrument. Methods: A cross-sectional study was conducted with a sample of 302 Spanish women who had given birth within the previous 6 months and were at least 1 week postpartum. Content, construct, and criterion validity, as well as reliability, were analysed using an expert panel, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Cronbach’s Alpha Coefficient, and Intraclass Correlation Coefficient (ICC). Criterion validity was assessed using the Generalised Anxiety Disorder Screener (GAD-7) and the Birth Satisfaction Scale–Revised (BSS-R). Results: The KMO test yielded a value of 0.925, and Bartlett’s test of sphericity was significant (p < 0.001). EFA identified three factors (Support, External control, and Internal control) that explained 56.49% of the total variance. CFA showed good model fit for most of the evaluated indices. The SCIB scale correlated negatively with the GAD-7 and positively with the BSS-R (p < 0.001), as well as with several obstetric and neonatal variables (p < 0.05): planned pregnancy, high-risk pregnancy, onset and type of delivery, birth plan, use of epidural analgesia, maternal involvement, postpartum complications, and newborn characteristics. Cronbach’s alpha was 0.951, and the ICC indicated excellent consistency and agreement (0.995; 95% CI: 0.990–0.998). Based on expert panel consensus, a 24-item abbreviated version was developed that exhibited psychometric properties similar to those of the original version and a high correlation with it (r > 0.90). Conclusions: The Support and Control in Birth (SCIB) scale is a valid and reliable instrument for assessing perceptions of support and control during birth in Spanish women. The 24-item abbreviated version is recommended. Full article

Objective: The objective of this study was to choose the optimal anesthesia method for gastric cancer patients undergoing surgery with lymph node dissection. Materials and Methods: The study included 53 patients with stage T1-4aN0-3M0 gastric cancer, who underwent radical surgery with xenon and dexmedetomidine (DMM) anesthesia in combination with epidural analgesia (main group, 27 patients) or with sevorflurane anesthesia in combination with epidural analgesia (comparison group, 26 patients). All patients underwent monitoring of hemodynamic parameters, blood coagulation system, thromboelastometry, and inflammation and metabolic parameters (interleukins, hormones and glucose levels), with an assessment of complications according to the Clavien-Dindo classification and the intensity of postoperative pain. Results: Awakening and extubation times, narcotic analgesic consumption, and Numeric Rating Scale pain scores were lower in the xenon + DMM group than in the sevoflurane group (p < 0.05). The overall number of patients experiencing complications did not differ significantly between anesthesia types; however, significant differences were found in the total number of complications (p = 0.003), the number of complications according to Clavien-Dindo I (p = 0.043) and II (p = 0.019), and the incidence of postoperative nausea and vomiting (p = 0.042). Conclusions: The BIS monitoring data obtained showed a sufficient level of anesthesia depth during surgery in both groups; however, post-anesthesia depression persisted longer in patients in sevoflurane group. Mathematical models for predicting Clavien-Dindo IIIb-V complications and severe postoperative pain syndrome are characterized by high sensitivity and specificity. They include simple clinical and laboratory parameters as well as type of anesthesia as predictors. The limitations of predictive models are also discussed in the article. Full article

Effective pain management during labor must balance adequate maternal pain relief with preservation of maternal participation and fetal safety. Epidural anesthesia remains the gold standard for labor analgesia. However, commonly used local anesthetics and opioid adjuvants are associated with adverse effects that include nausea, pruritus, urinary retention, and prolonged labor. Dexmedetomidine, a highly selective α₂ agonist, does not carry the same risks for misuse and abuse as opioids do and may be a promising non-opioid adjuvant for epidural labor analgesia due to its analgesic, anxiolytic, and opioid-sparing properties. Furthermore, dexmedetomidine has unique pharmacodynamic effects, including preserving maternal consciousness while providing adequate analgesia. This combination of consciousness preservation and sufficient analgesia suggests dexmedetomidine may be a promising pharmaceutic for epidural anesthesia. In addition to preserving maternal consciousness, dexmedetomidine does not appear to cause a clinically significant increase in the motor blockade. Although epidural analgesia is known to prolong labor in nulliparous and multiparous patients, the use of dexmedetomidine as an epidural adjuvant does not have a significant effect on labor duration in available trials. Across studies, dexmedetomidine does not have deleterious outcomes for neonates, measured using the neonatal Apgar score. Although dexmedetomidine is not currently FDA-approved for epidural labor analgesia, existing evidence from available trials suggests its safety and efficacy as an opioid-sparing adjuvant. This narrative review aims to highlight the current state of knowledge of dexmedetomidine’s pharmacology, efficacy, analgesic ability, and side effects. Full article

Background: Adequate analgesia is essential for enhanced recovery following major abdominal and thoracic surgery. Intravenous methadone has emerged as an alternative analgesic modality to traditional epidural analgesia. This study compares intravenous methadone with epidural analgesia in postoperative pain. Methods: We retrospectively analyzed adult patients who underwent laparotomy or non-cardiac thoracotomy between January 2019 and December 2022 and who had either general anesthesia with epidural analgesia or intravenous methadone. Co-primary outcomes were mean numeric rating scale (NRS) pain scores and cumulative opioid consumption from extubation until the end of postoperative day 2. Pain scores were obtained regularly from routine postoperative assessments documented in the electronic health record and were not recorded at predefined postoperative hours. Secondary outcomes related to analgesia, recovery, and clinical outcomes were examined. Results: We analyzed 796 adults (mean age 58 ± 15 years, 52% male, 68% ASA III–IV), of which 691 (87%) underwent laparotomy and 105 (13%) underwent non-cardiac thoracotomy. Patients receiving methadone had a higher postoperative NRS score (0.4 points, 95% CI 0.23 to 0.62, p < 0.001), with a mean NRS of 2.1 ± 1.4 points in the methadone group and 1.6 ± 1.2 points in the epidural group. The postoperative opioid consumption (morphine equivalent dose) was lower in the methadone group (23 ± 31 vs. 29 ± 43 mg, −7.2 mg, 95% CI −12.6 to −1.79, p = 0.009). Methadone was associated with earlier mobilization (−0.13 days, 95% CI −0.24 to −0.01, p = 0.030). Epidural patients had greater need for escalation of laxatives (26% vs. 15%, p = 0.016), while time to extubation was shorter (8.4 min, 95% CI 6.2 to 10.5, p < 0.001). No differences were observed in maximum NRS, oxygen demand, blood product transfusions, major adverse cardiac and cerebrovascular events, or length of stay. Conclusions: Methadone was associated with higher, clinically non-relevant postoperative pain scores and a clinically non-relevant reduction of postoperative opioid use. Full article

Corticosteroid receptor signaling in primary afferent neurons of the dorsal root ganglion (DRG) has emerged as a potential target to modulate nociception via genomic and nongenomic mechanisms shown in animal pain models. However, the expression landscape of glucocorticoid receptors (GRs) relative to mineralocorticoid receptors (MRs) in human DRG, their association with pain-related markers, and their functional relevance remain incompletely defined. We analyzed human and rat DRG by mRNA profiling and immunofluorescence confocal microscopy to assess GR/MR expression and complemented these studies with a clinical evaluation of neuraxial corticosteroid delivery. Here, GR transcripts in human DRG were the most abundant among corticosteroid receptor-related genes examined (including MR) and were observed alongside transcripts of pain-signaling molecules. Human DRG immunofluorescence analysis revealed substantial colocalization of GR with calcitonin gene-related peptide (CGRP), a marker of nociceptive unmyelinated C-fibers and thinly myelinated Aδ-fibers, as well as with gial fibrillary acidic protein (GFAP), a marker of satellite glial cells (SGCs), but minimal expression in myelinated neurofilament 200 (RT-200) immunoreactive (IR) human DRG neurons. In addition, GR immunoreactivity was primarily distributed to medium-diameter neurons (40–65 µm). Functionally, preclinical experiments showed that GR activation and MR blockade attenuate inflammatory pain via rapid, nongenomic neuronal mechanisms that counter an intrinsic mineralocorticoid receptor-mediated pronociceptive drive. Consistently, clinical analgesia over at least 3 months after transforaminal plus caudal epidural delivery of GR agonists in chronic radicular pain supports a functional role for neuronal GR signaling within spinal cord and DRG circuits. Together, these molecular, functional, and clinical findings identify GR as a key modulator of sensory neuron excitability and pain, highlight MR as a pronociceptive counterpart, and suggest that selectively enhancing GR signaling or inhibiting MR signaling may offer a potential strategy for improving corticosteroid-based analgesic therapies. Full article

Background: Epidural analgesia (EA) is widely used in pancreatic surgery but is associated with hypotension and delayed recovery. The shift towards minimally invasive surgery has led to the exploration of alternative multimodal analgesia strategies. Methadone, with its unique pharmacological properties, may further optimize recovery. Methods: This retrospective cohort study included 213 patients undergoing pancreatic resection, receiving EA (n = 63), multimodal analgesia without methadone (MA; n = 92), or with methadone (MM; n = 58). MA and MM included intravenous ketamine, lidocaine and continuous wound infiltration. Primary outcome was maximum daily postoperative pain scores. Secondary outcomes included opioid consumption, vasopressor use, mobilization, bowel recovery, urinary catheter duration, and ICU/hospital stay. Results: Compared with EA, pain scores were slightly higher in MM (mean difference 2.22; 95% CI 1.22–3.90; p = 0.01) and in MA (mean difference 2.06; 95% CI 0.99–4.30; p = 0.06). Opioid use was comparable between MM and EA (OR 0.99, 95% CI [0.98, 1.00], p = 0.20), and significantly lower in MA (OR 0.97, 95% CI [0.96, 0.98], p < 0.001). Both MA and MM demonstrated reduced vasopressor requirements (both 0 vs. 2.0 median days) and shorter urinary catheterization durations (MA 1.2 MM 1.9 vs. EA 4.0 median days). MA improved mobilization (0 vs. 1 median days; OR 0.52, p = 0.03) and bowel recovery (OR 0.76, p = 0.02). ICU stay was longer in EA due to routine ICU admission for open surgery. Conclusions: Multimodal analgesia, with or without methadone, offers alternative strategies in pancreatic surgery. While EA provides superior pain control, multimodal regimens are associated with improved functional recovery. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article