Abstract: Aim: This study aimed to compare the effectiveness of epidural anesthesia (EA) and general anesthesia (GA) in managing postoperative pain, opioid consumption, time to first analgesic requirement, incidence of adverse events, and hospital stay duration in patients undergoing elective abdominal surgeries.

Materials & Methods: This prospective, randomized controlled trial included 100 adult patients scheduled for elective abdominal surgery, with 50 patients each in the EA and GA groups. Epidural anesthesia involved administering 0.5% Bupivacaine at the T10–L2 level, followed by an infusion of 0.125% Bupivacaine with Fentanyl (2 μg/mL). General anesthesia included Propofol for induction and Isoflurane with intermittent Fentanyl boluses for maintenance. Postoperative pain scores were assessed using the Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours. Secondary outcomes included total opioid consumption, time to first analgesic requirement, adverse events, and length of hospital stay.

Results: The demographic and clinical characteristics were comparable between groups. Postoperative pain scores were significantly lower in the EA group at all time intervals (p< 0.001). Total opioid consumption (5.2 ± 1.8 mg vs. 12.4 ± 3.5 mg, p< 0.001) and the number of breakthrough analgesic doses (1.2 ± 0.5 vs. 2.8 ± 0.8, p< 0.001) were significantly lower in the EA group. Time to first analgesic requirement was longer in the EA group (6.8 ± 1.5 hours vs. 3.2 ± 1.0 hours, p< 0.001). The incidence of nausea and vomiting was significantly lower in the EA group (12% vs. 36%, p = 0.003). The EA group also had a shorter hospital stay (4.2 ± 1.1 days vs. 5.8 ± 1.4 days, p< 0.001).

Conclusion: Epidural anesthesia demonstrated superior postoperative pain control, reduced opioid consumption, prolonged analgesic duration, fewer adverse events, and shorter hospital stays compared to general anesthesia. These findings highlight the advantages of epidural anesthesia as an effective option for managing postoperative pain in abdominal surgeries.