Perioperative Complications and Recovery Profile in Patients Receiving Regional Versus General Anesthesia for Lower Limb Surgeries: An Observational Study
DOI:
https://doi.org/10.51168/ewf9hd75Keywords:
regional anesthesia, general anesthesia, lower limb surgery, postoperative complications, recovery, painAbstract
Background: Regional anesthesia is widely used for lower limb surgery, yet institutional outcome data comparing regional and general anesthesia in routine elective practice remain limited.
Objectives: To compare perioperative complications, postoperative pain, and early recovery outcomes between patients receiving regional anesthesia and those receiving general anesthesia for elective lower limb surgeries.
Methods: This prospective observational study was conducted at Mamata Medical College, Khammam, Telangana, India, from March 2025 to August 2025. One hundred adult patients scheduled for elective lower limb surgery were enrolled using consecutive sampling: 50 received regional anesthesia and 50 received general anesthesia as per anesthesiologist and surgical requirements. Intraoperative events (hypotension, tachycardia, vasopressor use, nausea/vomiting, airway interventions) and postoperative outcomes (postoperative nausea and vomiting, shivering, urinary retention, pain score at 6 hours, rescue analgesic requirement, time to oral intake, time to ambulation, and hospital stay) were recorded and compared using appropriate statistical tests with p<0.05 considered significant.
Results: Baseline demographics, ASA status, and surgical duration were comparable between groups. General anesthesia was associated with higher intraoperative hypotension, tachycardia, and vasopressor requirement, and more frequent airway-related interventions. Postoperative nausea and vomiting and early postoperative pain scores were higher after general anesthesia, with greater rescue analgesic requirement. Regional anesthesia showed earlier ambulation and oral intake and a shorter hospital stay, while urinary retention occurred more often after regional anesthesia.
Conclusion: For elective lower limb surgeries, regional anesthesia demonstrated a more favorable hemodynamic profile, better early analgesia, and faster recovery compared with general anesthesia, whereas general anesthesia was associated with higher postoperative nausea and vomiting.
Recommendations: Where feasible, regional anesthesia should be considered as a primary technique for elective lower limb surgeries, alongside protocols for early mobilization and active surveillance for urinary retention.
References
1. Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016 Feb;116(2):163-176. https://doi.org/10.1093/bja/aev455
2. Zorrilla-Vaca A, Grant MC, Mathur V, Li J, Wu CL. The impact of neuraxial versus general anesthesia on the incidence of postoperative surgical site infections following knee or hip arthroplasty: a meta-analysis. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):555-563. https://doi.org/10.1097/AAP.0000000000000437
3. Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ. Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am. 2013 Feb 6;95(3):193-199. https://doi.org/10.2106/JBJS.K.01682
4. Kendall MC, Cohen AD, Principe-Marrero S, Sidhom P, Apruzzese P, De Oliveira G. Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol. 2021 Sep 15;21(1):226. https://doi.org/10.1186/s12871-021-01442-2
5. Tirumala V, Bounajem G, Klemt C, Maier SP, Padmanabha A, Kwon YM. Outcome of spinal versus general anesthesia in revision total hip arthroplasty: a propensity score-matched cohort analysis. J Am Acad Orthop Surg. 2021 Jul 1;29(13):e656-e666. https://doi.org/10.5435/JAAOS-D-20-00797
6. Owen AR, Amundson AW, Larson DR, Duncan CM, Smith HM, Johnson RL, et al. Spinal versus general anesthesia in contemporary revision total knee arthroplasties. J Arthroplasty. 2023 Jun;38(6 Suppl): S271-S274.e1. https://doi.org/10.1016/j.arth.2023.01.053
7. Vail EA, Feng R, Sieber F, Carson JL, Ellenberg SS, Magaziner J, et al; REGAIN Investigators. Long-term outcomes with spinal versus general anesthesia for hip fracture surgery: a randomized trial. Anesthesiology. 2024 Mar 1;140(3):375-386. https://doi.org/10.1097/ALN.0000000000004807
8. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999 Sep;91(3):693-700. https://doi.org/10.1097/00000542-199909000-00022
9. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020 Aug;131(2):411-448. https://doi.org/10.1213/ANE.0000000000004833
10. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
11. Myles PS, Myles DB, Gallagher W, Boyd D, Chew C, MacDonald N, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017 Mar 1;118(3):424-429. https://doi.org/10.1093/bja/aew466
12. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806-808. https://doi.org/10.1136/bmj.39335.541782.AD
13. Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998 Jun;13(3):148-155. https://doi.org/10.1016/S1089-9472(98)80044-0
14. Scholten R, Kremers K, van de Groes SAW, Somford DM, Koëter S. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing fast-track total joint arthroplasty: a prospective observational study on 371 patients. J Arthroplasty. 2018 May;33(5):1546-1551. https://doi.org/10.1016/j.arth.2017.12.001
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