Impact of Modern Anesthetic Techniques on Early Post-Operative Recovery and Patient-Reported Outcomes

Abstract

Background: Modern anesthetic techniques including total intravenous anesthesia (TIVA), multimodal analgesia, and ultrasound-guided regional blockade aim to improve early postoperative recovery and patient-reported outcomes (PROs). Data from district/secondary hospitals in Bangladesh are limited. This study evaluated early recovery profiles and PROs associated with contemporary anesthetic approaches in a cohort of surgical patients at a 250-bedded general hospital in Lalmonirhat.

Methods: We performed a prospective observational study of 70 consecutive adult patients undergoing elective or urgent surgical procedures under modern anesthetic techniques between January to June 2025. Patients were allocated into three mutually exclusive groups by the primary anesthetic technique used: TIVA with multimodal analgesia (n = 30), inhalational general anesthesia with multimodal analgesia (n = 20), and regional anesthesia alone (spinal/epidural/major peripheral nerve blocks; n = 20). Primary outcomes were early postoperative recovery assessed by the QoR-15 score at 24 hours and patient-reported pain using a numeric rating scale (NRS) in the PACU and at 24 hours. Secondary outcomes included opioid consumption (morphine milligram equivalents, MME) within 24 hours, incidence of postoperative nausea and vomiting (PONV), PACU length of stay, and overall patient satisfaction (0–10).

Results: Mean age was 41.2 ± 14.6 years; 38 (54.3%) were female. Distribution: TIVA 30/70 (42.9%), inhalational 20/70 (28.6%), regional 20/70 (28.6%). Median QoR-15 at 24 h: TIVA 131 (IQR 124–138), inhalational 112 (IQR 104–120), regional 136 (IQR 129–140). Mean PACU NRS pain scores were lower after TIVA (2.1 ± 1.0) and regional anesthesia (1.8 ± 0.9) than inhalational anesthesia (3.5 ± 1.2) (ANOVA p < 0.001). Mean 24-hour opioid consumption: TIVA 8.0 ± 4.0 mg MME, inhalational 12.0 ± 5.0 mg, regional 5.0 ± 3.0 mg (p < 0.001). PONV incidence: TIVA 3/30 (10.0%), inhalational 6/20 (30.0%), regional 1/20 (5.0%) (χ² p = 0.04). Mean patient satisfaction: TIVA 9.0 ± 0.8, inhalational 7.8 ± 1.2, regional 9.2 ± 0.6 (p < 0.001). PACU length of stay was shortest for regional anesthesia (mean 60 ± 20 min), followed by TIVA (90 ± 30 min) and inhalational (120 ± 45 min) (p < 0.001).

Conclusions: In this single-center cohort, modern anesthetic techniques (TIVA and regional anesthesia combined with multimodal analgesia) were associated with improved early postoperative recovery, lower pain scores and opioid consumption, less PONV, shorter PACU stays, and higher patient satisfaction compared with inhalational techniques. These findings support wider adoption of modern, multimodal approaches in similar hospital settings in Bangladesh. Larger, randomized studies at district hospitals are warranted.