Regional Versus General Anesthesia in Major Elective Surgeries: An Umbrella Review of Clinical Outcomes and Perioperative Efficiency

Abstract

Background: Anesthesia is an essential part of most surgical procedures, providing optimal conditions and patient comfort. Although general anesthesia remains the standard for most elective surgeries, regional anesthesia is becoming popular, especially in orthopedic procedures. However, the relative clinical safety and effectiveness of regional anesthesia compared with general anesthesia in major elective surgeries remain under investigation. Methods: An umbrella systematic literature review was performed in adherence to the PRISMA, AMSTAR-2, and PRIOR guidelines. Electronic databases, including PubMed, the Cochrane Library, and Scopus were searched for relevant studies. A total of 40 systematic literature reviews and meta-analyses were included in the article. The primary outcome was short-term (90-day) mortality; secondary outcomes included intraoperative outcomes, perioperative complications, patient-reported outcomes, and tumor therapy-related variables. Results: No major differences in 90-day mortality were observed among the anesthesia methods. Similarly, in presurgical, intraoperative, and tumor therapy-related variables, no significant advantage was observed for either anesthesia method. However, regional anesthesia consistently demonstrated shorter in-hospital stay, superior control of postoperative nausea and vomiting, and better pain control. Conclusion: Based on the derived results, regional anesthesia could be an effective and safe option for major elective surgeries, with potential advantages in post-surgical recovery parameters.