Effects of epidural analgesia, regional blockade, and intravenous PCIA on early postoperative sleep disturbance and recovery outcomes after gastric and colorectal cancer surgery: a propensity score–based retrospective cohort study

BACKGROUND: Early postoperative sleep disturbance is common after major abdominal cancer surgery and may hinder recovery. Whether analgesic strategy influences early sleep outcomes in gastric and colorectal cancer surgery remains uncertain. METHODS: We conducted a single center retrospective cohort study of consecutive patients undergoing curative intent gastric or colorectal cancer surgery. Patients received postoperative analgesia with epidural analgesia, regional blockade, or intravenous patient-controlled analgesia (IV PCIA). The primary outcome was early postoperative sleep disturbance. Secondary outcomes included early pain scores, opioid consumption, postoperative nausea and vomiting, functional recovery metrics, length of stay, and postoperative morbidity. Associations were evaluated using multivariable regression and generalized propensity score methods, including inverse probability of treatment weighting (IPTW) and 1:1:1 three group triplet matching. RESULTS: Among 860 patients, 267 received epidural analgesia, 237 received regional blockade, and 356 received IV PCIA. Early postoperative sleep disturbance occurred in 476 patients (55.3%) and differed by strategy, 46.1% with epidural, 50.6% with regional blockade, and 65.4% with IV PCIA (global P < 0.001). In multivariable logistic regression, epidural analgesia and regional blockade were each associated with lower odds of sleep disturbance versus IV PCIA, adjusted odds ratio 0.447 (95% confidence interval 0.320 to 0.624) and 0.526 (0.372 to 0.743), both P < 0.001. Intraoperative sedative exposure was independently associated with higher odds of sleep disturbance, adjusted odds ratio 1.374 (1.038 to 1.818), P = 0.026. Epidural and regional blockade were also associated with lower early pain scores and reduced 48 h opioid consumption, 95.71 ± 20.67 and 103.52 ± 22.38 morphine milligram equivalents (MME) versus 120.54 ± 20.69 MME with IV PCIA (global P < 0.001). Length of stay was shorter with epidural versus IV PCIA after adjustment and IPTW, approximately 0.9 days. Results were directionally consistent under IPTW and three group matching. CONCLUSIONS: In gastric and colorectal cancer surgery, epidural analgesia and regional blockade were associated with less early postoperative sleep disturbance and more favorable early recovery metrics compared with IV PCIA. Prospective studies with validated sleep measures are warranted to confirm causality and define optimal sleep centered analgesia pathways.