Analgesic approaches and their effects on respiratory outcome after laparoscopic surgery: A Prospective Observational Cohort Study

Background Postoperative analgesia is critical for patient recovery but significantly influences respiratory mechanics, particularly following laparoscopic procedures. While various analgesic modalities exist, their comparative impact on pulmonary function remains a subject of clinical investigation. This study evaluates the efficacy of Epidural Analgesia (EA), Intravenous (IV) Opioids, and Patient-Controlled Analgesia (PCA) regarding postoperative pulmonary function and respiratory outcomes. Methods A prospective observational cohort study was conducted on 40 patients undergoing laparoscopic surgery at a tertiary care hospital. Patients were categorized into three groups based on the analgesic technique administered: IV opioids (n = 15), EA (n = 12), and PCA (n = 13). Primary outcomes included postoperative Forced Expiratory Volume in 1 second (FEV ¹ ), respiratory rate, and oxygen saturation (SpO ₂ ). Secondary outcomes included pain scores, incidence of respiratory complications, and length of hospital stay. Results The IV opioid group exhibited the most significant postoperative decline in FEV ¹ (from 97.5% to 80.2%) and the highest requirement for supplemental oxygen (53.3%). Conversely, the EA group demonstrated superior preservation of pulmonary function (FEV ¹ post-op: 88.1%) and the lowest incidence of respiratory complications (8.3%). Patients receiving EA reported significantly lower mean pain scores (2.7 ± 1.1) compared to the IV opioid (4.9 ± 1.3) and PCA (3.5 ± 1.2) groups. Consequently, the EA group had the shortest mean hospital stay (2.4 days) compared to IV opioids (3.8 days). Conclusion Epidural analgesia provides superior preservation of postoperative pulmonary function and effective pain control with fewer respiratory complications compared to IV opioids and PCA. While PCA offers moderate benefits over systemic opioids, IV opioids are associated with a higher risk of respiratory depression and prolonged hospital stay. Epidural analgesia is recommended to optimize respiratory recovery in laparoscopic surgery.