Comparative evaluation of perioperative multimodal analgesia and single-bolus epidural analgesia in lower abdominal surgery: a randomized controlled study

Background: Effective postoperative pain management is essential for enhanced recovery after lower abdominal surgeries. While epidural analgesia has been widely used, multimodal analgesia offers a less invasive, opioid-sparing alternative. This study aimed to compare perioperative multimodal analgesia using pregabalin, nefopam, and paracetamol with epidural analgesia in terms of analgesic efficacy and recovery outcomes. Methods: This prospective, randomized, single-blind study included 70 female patients (ASA I-II) undergoing lower abdominal surgeries under general anesthesia. Patients were allocated into two groups: Group A (multimodal analgesia) and group B (epidural analgesia). Postoperative pain (VAS score), hemodynamic parameters, time to first rescue analgesia, total rescue analgesic requirement, adverse effects, and time to ambulation were recorded over 24 hours. Statistical analysis was performed using independent t test and Fisher’s exact test. Results: Baseline characteristics were comparable between groups. The multimodal group demonstrated significantly lower early postoperative pain scores and prolonged time to first rescue analgesia (147±94 vs 107±72 minutes, p=0.049). Fewer patients required ≥3 rescue doses (17.1% vs 40.0%). Hemodynamic parameters were largely comparable, although episodic elevations were observed in the epidural group. Time to ambulation was significantly shorter in the multimodal group (34.83±5.10 vs 37.94±5.25 hours, p=0.014). Adverse effects such as nausea, headache, and shivering were more frequent in the epidural group, though not statistically significant. Conclusions: Perioperative multimodal analgesia provides effective pain control, reduces analgesic requirements, and facilitates earlier ambulation compared to epidural analgesia. It represents a safe, practical, and effective alternative for postoperative pain management in lower abdominal surgeries.