Epidural-Based Multimodal Analgesia and Early Postoperative Recovery after Elective Open Abdominal Aortic Aneurysm Repair: A Prospective Observational Cohort Study.

BACKGROUND

To evaluate whether the addition of epidural analgesia to general anesthesia is associated with improved early postoperative ICU recovery in patients undergoing elective open abdominal aortic aneurysm (AAA) repair.

METHODS

Prospective, single-center observational cohort study. Tertiary care university-affiliated vascular surgery center. Sixty adult patients undergoing elective open AAA repair between August 2024 and July 2025. Patients received either general anesthesia alone (GA group, n = 30) or combined general anesthesia with epidural analgesia as part of a multimodal analgesic strategy (GA + EA group, n = 30), based on anesthesiologist clinical judgment and patient-specific factors.

RESULTS

The primary outcome was early postoperative ICU recovery, assessed by postoperative mechanical ventilation time and ICU length of stay. Secondary outcomes included perioperative opioid consumption and intraoperative hemodynamic parameters (vasopressor requirements and fluid administration). The GA + EA group demonstrated significantly shorter postoperative mechanical ventilation time (1.5 ± 1.0 vs 5.0 ± 2.0 hours, P = 0.00000008) and ICU length of stay (1.0 ± 0.5 vs 2.0 ± 0.9 days, P = 0.000003). Additionally, patients in the GA + EA group required lower intraoperative opioid doses (fentanyl 3.5 ± 1.0 vs 8.5 ± 1.6 μg/kg, P = 2.63 × 10-19) and reduced 24-hour postoperative morphine consumption (2 ± 4 vs 18 ± 6 mg, P = 1.30 × 10-16). Mean intraoperative MAP, heart rate, the proportion of patients with MAP <60 mm Hg, and norepinephrine requirement did not differ significantly between groups. Intraoperative crystalloid administration was lower in the GA + EA group, while colloid use, blood loss, cell-saver volumes, and transfusion requirements were comparable.

CONCLUSION

This exploratory, hypothesis-generating study found that epidural-based multimodal analgesia was associated with improved early postoperative ICU recovery following open AAA repair, particularly through earlier extubation and shorter ICU stay. Integration of neuraxial techniques within multimodal perioperative care pathways may represent a feasible strategy to optimize recovery in high-risk vascular surgery.