Feasibility and Cost-Effectiveness of Peripheral Nerve Blocks for Minor Day-Care Surgeries in a Provincial Hospital in Janakpur, Nepal: A Prospective Observational Study

Background: Day-care surgery is expanding in low- and middle-income countries (LMICs) as a strategy to improve surgical access and reduce costs. Peripheral nerve blocks (PNBs) offer an alternative to general anesthesia (GA) for minor procedures, but evidence on their feasibility and cost-effectiveness in provincial Nepalese hospitals remains limited. Methods: This prospective observational study was conducted in the Department of Anaesthesia at the Madhesh Institute of Health Sciences (MIHS) Provincial Hospital, Janakpur, Nepal, over one year (May 2025 – May 2026). A total of 360 adult patients undergoing minor day-care surgeries were allocated to either PNB (n=180) or GA (n=180) based on clinical suitability and patient preference. Primary outcomes were total perioperative cost (in Nepalese Rupees, NPR), recovery time (minutes to discharge readiness), and postoperative pain scores (Numeric Rating Scale, NRS). Secondary outcomes included patient satisfaction (Likert scale), adverse events, and conversion to GA. Data were analyzed using SPSS version 26.0. Continuous variables were compared using independent samples t-tests; categorical variables using chi-square tests. A p-value <0.05 was considered statistically significant. Results: The mean total perioperative cost was significantly lower in the PNB group (NPR 4,250 ± 620) compared to the GA group (NPR 6,780 ± 890), p < 0.001. Mean time to discharge readiness was shorter with PNB (142 ± 28 minutes) versus GA (268 ± 45 minutes), p < 0.001. Postoperative NRS scores at 2, 6, and 12 hours were significantly lower in the PNB group (p < 0.001). Patient satisfaction was higher in the PNB group (median 9/10 vs. 7/10, p < 0.001). Block success rate was 94.4% (170/180), with 5.6% (10/180) requiring conversion to GA. No major complications were observed; minor adverse events occurred in 8.9% of PNB patients versus 15.6% of GA patients (p = 0.045). Conclusion: Peripheral nerve blocks are feasible, cost-effective, and associated with faster recovery and superior analgesia compared to GA for minor day-care surgeries in a provincial Nepalese hospital. Wider implementation of PNB services, supported by affordable ultrasound technology and structured training, is recommended to enhance surgical capacity in resource-limited settings.