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

Analgesic approaches and their effects on respiratory outcome after laparoscopic surgery: A Prospective Observational Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analgesic approaches and their effects on respiratory outcome after laparoscopic surgery: A Prospective Observational Cohort Study Mercy Allen Namutebi, Lopa Patel, Sampreeth Naidu Yellapu, Hemantkumar Patadia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8520415/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Epidural analgesia Intravenous opioids Laparoscopic surgery Patient-controlled analgesia Postoperative analgesia Pulmonary function Figures Figure 1 Figure 2 Introduction In the last decade, medical centers worldwide have widely adopted laparoscopic surgery as the standard intervention for treating chronic asymptomatic cholecystitis and gallstones. While this minimally invasive approach offers significant benefits, a significant decrease in diaphragmatic activity is often observed immediately following surgery, although patients typically demonstrate rapid recovery by the first postoperative day [ 3 ]. Recent findings indicate that compared to open surgery, laparoscopic procedures result in less impairment of lung function and arterial blood gas levels. It is hypothesized that this relative preservation of pulmonary function may correlate with a reduced incidence of postoperative pulmonary complications [ 1 ]. However, intraoperative factors such as patient positioning, carbon dioxide (CO2) insufflation, and diaphragmatic elevation can significantly reduce lung expansion, increase airway pressure, and cause transient hypercapnia and hypoxemia [ 2 ]. A comparative analysis of different analgesic techniques is necessary to determine the optimal method that balances effective pain control with minimal impact on pulmonary function. This study evaluates the existing evidence regarding various postoperative analgesic methods and their specific impact on pulmonary mechanics in patients undergoing laparoscopic surgery. By critically evaluating the relationship between pain management practices and respiratory outcomes, this article aims to identify the analgesic approaches that best maintain or enhance postoperative pulmonary function while providing sufficient pain relief [ 5 ]. Gaining an understanding of these physiological connections is crucial for developing clinical recommendations that reduce pulmonary complications, improve patient comfort, and optimize recovery outcomes [ 6 ]. Although laparoscopic surgery offers advantages such as reduced mortality rates, shorter hospital stays, faster recovery, and decreased postoperative pain, it can still result in significant alterations to respiratory health. Postoperatively, patients may experience declines in forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and functional residual capacity (FRC). These physiological changes can precipitate respiratory complications including atelectasis, pneumonia, tracheobronchial infection, and respiratory failure, all of which contribute to prolonged hospital stays. Multiple factors, including the analgesic technique selected for postoperative pain management, combine to influence this postoperative dysfunction [ 4 ] [ 11 ]. Considering the growing emphasis on enhanced recovery protocols, the selection of analgesia—specifically Intravenous (IV) Opioids, Patient-Controlled Analgesia (PCA), or Epidural Analgesia—is a critical determinant of postoperative pulmonary outcomes. Each technique impacts effectiveness, side effect profiles, and respiratory physiology differently. Unlike epidural analgesia, which provides localized pain management with minimal systemic influence, intravenous opioids may significantly depress respiratory drive despite providing effective pain relief. PCA allows patients to self-administer analgesia; however, its respiratory effects vary significantly based on usage patterns. It is essential to investigate how these different approaches affect lung function, gas exchange, and the development of pulmonary complications to guide clinical judgment and tailor pain management for optimal recovery. Methodology Study Design and Setting This prospective observational cohort study was conducted at Parul Sevashram Hospital to assess the comparative effects of different analgesic modalities on postoperative pulmonary outcomes. The study utilized a quantitative non-experimental design to observe patients in a clinical setting without altering their standard surgical or anesthetic care. Ethical Considerations The study was conducted in accordance with the ethical principles and was approved by the Parul University Institutional Ethics Committee on Human Research (PU-IECHR) (Approval Number: PUIECHR/PIMSR/00/081734/8117 ). Written informed consent was obtained from all participants prior to their Enrollment in the study, and they were informed of their right to withdraw at any stage without compromising their care. Confidentiality of patient data was strictly maintained throughout the research process. Study Population and Sampling A purposive sampling technique was employed to recruit a total of 40 patients undergoing elective laparoscopic surgery. Patients were categorized into three groups based on the postoperative analgesic technique prescribed by the attending anesthesiologists: Group IV : Patients receiving Intravenous Opioids (n = 15) Group EA : Patients receiving Epidural Analgesia (n = 12) Group PCA : Patients receiving Patient-Controlled Analgesia (n = 13) Inclusion and Exclusion Criteria The study included adult patients of both genders undergoing elective laparoscopic procedures who consented to participate. To ensure the validity of respiratory outcome data, strict exclusion criteria were applied. Patients with a history of significant pre-existing pulmonary pathologies, specifically Chronic Obstructive Pulmonary Disease (COPD) or bronchial asthma, were excluded from the study to prevent confounding variables regarding baseline lung function. Data Collection and Outcome Measures Data collection was performed systematically in the postoperative recovery unit. The primary respiratory parameters assessed included Respiratory Rate (RR), Oxygen Saturation (SpO2), and pulmonary function tests, specifically Forced Expiratory Volume in 1 second (FEV_1). Baseline values were recorded preoperatively and compared with postoperative values to determine the degree of respiratory deviation. Secondary outcomes included pain scores assessed using a standard pain scale, the incidence of respiratory complications (e.g., atelectasis, desaturation), and the total length of hospital stay. Statistical Analysis Data were compiled and analysed to evaluate the relationship between the analgesic technique used and postoperative outcomes. Quantitative variables, including respiratory rates and FEV 1 , were expressed as Mean±, Standard Deviation (SD). Categorical variables such as the incidence of complications were presented as frequencies and percentages. Comparative analysis was conducted to determine statistical significance between the groups, ensuring a reliable evaluation of the impact of each analgesic method on recovery. Results Table 1 Distribution of Patients by Demographic Variables (N = 40) Demographic Variable Category Frequency (n) Percentage (%) Age 18–25 years 6 15% 26–35 years 10 25% 36–45 years 14 35% > 45 years 10 25% Gender Male 24 60% Female 16 40% Marital Status Married 30 75% Unmarried 10 25% Educational Status Primary 8 20% Secondary 12 30% Tertiary 16 40% No formal education 4 10% Employed 18 45% Occupation Unemployed 8 20% Housewife 10 25% Others 4 10% Place of Residence Urban 28 70% Rural 12 30% Demographic Characteristics A total of 40 patients undergoing laparoscopic surgery were included in the study. The demographic distribution of the study population is presented in Table 1 . The majority of participants were male (60%) and married (75%). Regarding age distribution, the largest subgroup was aged 36–45 years (35%). In terms of residence, 70% of patients resided in urban areas, while 30% were from rural backgrounds. Educational status varied, with 40% of participants having completed tertiary education. Table 2 Distribution of patients by analgesic technique Analgesic Technique Number of Patients (n) Percentage (%) IV Opioids 15 37.5% Epidural Analgesia 12 30% PCA 13 32.5% Total 40 100% Distribution of Analgesic Techniques Patients were categorized into three groups based on the postoperative analgesic modality administered: Intravenous (IV) Opioids ( $ n = 15 $ , 37.5%), Patient-Controlled Analgesia (PCA) ( $ n = 13 $ , 32.5%), and Epidural Analgesia (EA) ( $ n = 12 $ , 30%). This distribution is summarized in Table 2 . Table 3 Comparison of Pre- and Postoperative Respiratory Parameters by Analgesic Technique Analgesic Technique Pre-op Respiratory Rate (Mean ± SD) Post-op Respiratory Rate (Mean ± SD) Pre-op FEV1 (% Predicted) Post-op FEV1 (% Predicted) IV Opioids 14.2 ± 1.5 bpm 18.5 ± 2.1 bpm 97.5 ± 5.3% 80.2 ± 6.5% Epidural Analgesia 13.8 ± 1.2 bpm 14.6 ± 1.8 bpm 96.8 ± 4.9% 88.1 ± 5.7% PCA 14.0 ± 1.3 bpm 15.5 ± 1.9 bpm 97.0 ± 5.1% 83.9 ± 5.9% Respiratory Outcomes and Pulmonary Function The comparison of preoperative and postoperative respiratory parameters is detailed in Table 3 . Baseline preoperative respiratory rates (RR) and Forced Expiratory Volume in 1 second FEV 1 were comparable across all three groups. Postoperatively, the IV Opioid group exhibited the most significant deviation from baseline, with a mean respiratory rate increasing to 18.5 ± 2.1 bpm and FEV 1 declining to 80.2 ± 6.5% of the predicted value. The PCA group showed moderate changes (RR: 15.5 ± 1.9 bpm; FEV1: 83.9 ± 5.9%). The Epidural Analgesia group demonstrated the highest preservation of pulmonary function, with a postoperative FEV 1 of 88.1 ± 5.7% and minimal increase in respiratory rate (14.6 ± 1.8 bpm). Table 4 Postoperative Oxygen Requirement and Respiratory Complications by Analgesic Technique Analgesic Technique Patients Needing Oxygen (n/total) Percentage Needing Oxygen (%) Patients with Respiratory Complications (n/total) Percentage with Complications (%) IV Opioids 8/15 53.3% 4/15 26.7% Epidural Analgesia 2/12 16.7% 1/12 8.3% PCA 4/13 30.8% 2/13 15.4% Oxygen Requirement and Complications Table 4 presents the incidence of postoperative oxygen requirements and respiratory complications. The IV Opioid group had the highest requirement for supplemental oxygen (53.3%) and the highest incidence of respiratory complications (26.7%). In contrast, the Epidural Analgesia group had the lowest oxygen requirement (16.7%) and complication rate (8.3%). Pain Scores and Hospital Stay Pain intensity and length of hospital stay varied significantly by analgesic technique. As illustrated in Fig. 1 , the mean length of hospital stay was longest in the IV Opioid group (3.8 days), followed by the PCA group (3.0 days), and shortest in the Epidural Analgesia group (2.4 days). Regarding pain management efficacy (Fig. 2 ), the IV Opioid group reported the highest mean pain scores (4.9 ± 1.3). The PCA group reported moderate pain scores (3.5 ± 1.2), while the Epidural Analgesia group reported the lowest mean pain scores (2.7 ± 1.1). Table 5 Link between Postoperative Pulmonary Outcomes and Demographic Factors. Demographic Variable Outcome Chi-square df p-value Interpretation Gender FEV1 4.38 1 0.036 Males had significantly lower FEV1 than females Oxygen Requirement 6.10 1 0.013 Males required oxygen more than females Complications 5.90 1 0.015 More complications in males than female Hospital Stay 3.52 1 0.061 Not significant Age Group FEV1 6.25 3 0.100 Not significant across age groups Hospital Stay 5.82 3 0.089 Not significant Oxygen Requirement 4.70 3 0.105 Not significant Satisfaction 4.75 3 0.190 Not significant Place of Residence FEV1 4.95 1 0.026 Rural patients had lower FEV1 than urban Hospital Stay 6.30 1 0.012 Rural patients had longer hospital stays Complications 5.12 1 0.023 More complications in rural patients Association Between Demographic Variables and Outcomes The impact of demographic factors on postoperative outcomes was analysed using Chi-square tests (Table 5 ). Gender showed a statistically significant association with FEV_1 (p = 0.036), oxygen requirement (p = 0.013), and complication rates (p = 0.015), with male patients exhibiting lower FEV_1 and higher complication rates compared to females. Place of residence was also significantly associated with clinical outcomes; patients from rural areas had significantly lower FEV_1 (p = 0.026), higher complication rates (p = 0.023), and longer hospital stays (p = 0.012) compared to urban residents. Age, marital status, educational status, and occupation did not show statistically significant correlations with respiratory outcomes or length of hospital stay (p > 0.05). Discussion of results This prospective observational study evaluated the impact of three distinct analgesic modalities—Intravenous (IV) Opioids, Patient-Controlled Analgesia (PCA), and Epidural Analgesia (EA)—on postoperative pulmonary function and respiratory outcomes following laparoscopic surgery. The principal finding of this study is that Epidural Analgesia significantly preserves postoperative lung function, as evidenced by higher FEV 1 values, reduced oxygen requirements, and shorter hospital stays compared to systemic opioid-based regimens. Conversely, IV opioids were associated with the most profound respiratory depression and the highest incidence of pulmonary complications. Impact of Analgesia on Pulmonary Mechanics Laparoscopic surgery, despite being minimally invasive, induces temporary diaphragmatic dysfunction and alters pulmonary mechanics [ 3 ]. Our results indicated that patients receiving IV opioids experienced a significant decline in FEV 1 (80.2% of predicted) and a high rate of supplemental oxygen dependence (53.3%). This aligns with the physiological mechanisms described by Palkovic et al., who highlighted that systemic opioids act on mu-opioid receptors in the brainstem to depress respiratory drive and reduce tidal volume [ 7 ]. Furthermore, the sedative effects of bolus IV opioids often discourage deep breathing and early mobilization, exacerbating atelectasis. This finding corroborates the work of Overdyk et al., who identified opioid-induced respiratory depression (OIRD) as a significant, often underreported hazard in acute care settings [ 8 , 11 ]. Superiority of Epidural Analgesia In contrast to systemic opioids, the Epidural Analgesia group demonstrated superior preservation of pulmonary function (FEV 1 88.1%) and the lowest pain scores (2.7 1.1). This accords with the meta-analysis by Pöpping et al., which established that epidural analgesia reduces the odds of pneumonia and respiratory failure after abdominal surgery by providing potent, segmental analgesia without central nervous system depression [ 9 ]. By effectively blocking nociceptive input, epidural analgesia allows patients to cough and breathe deeply without pain-induced splinting. Our data supports the conclusion that epidural techniques are integral to Enhanced Recovery After Surgery (ERAS) protocols, as suggested by Nimmo et al., facilitating earlier mobilization and reduced hospital stays (2.4 days in our EA group) [ 5 ]. The Role of Patient-Controlled Analgesia (PCA) Our study observed that PCA offered intermediate results between IV opioids and EA. While PCA provided better pain control and patient satisfaction than nurse-administered IV opioids, it was still associated with a moderate decline in FEV 1 (83.9%) and a 30.8% oxygen requirement. This reflects the "double-edged" nature of PCA described by Kee and Lam; while self-titration reduces the risk of massive overdose compared to large boluses, the cumulative dose of opioids still poses a risk for respiratory depression, particularly during sleep [ 10 ]. Etches et al. similarly noted that while PCA improves comfort, it does not eliminate the risk of hypoventilation [ 12 ]. Therefore, while PCA is preferable to intermittent IV boluses, it remains inferior to epidural analgesia regarding pulmonary preservation. Demographic Influences on Respiratory Outcomes We identified that male gender and rural residence were associated with poorer respiratory outcomes. The correlation between male gender and lower FEV 1 may be attributed to differences in body fat distribution and diaphragmatic mechanics, as noted in studies on post-laparoscopic pulmonary function [ 4 ]. The disparity in outcomes based on residence may reflect preoperative health literacy or delayed presentation for surgery, although this requires further investigation. Clinical Implications The choice of analgesic technique is not merely a matter of comfort but a critical determinant of respiratory safety. As emphasized by Joshi et al., procedure-specific pain management is essential for improving outcomes [ 11 ]. Our findings suggest that for patients at high risk of respiratory complications, or those undergoing prolonged laparoscopic procedures, epidural analgesia should be the preferred modality. For patients where neuraxial anesthesia is contraindicated, multimodal analgesia with reduced opioid reliance should be prioritized to mitigate the risks of respiratory depression detailed by Rawal [ 6 ]. Limitations This study was limited by its observational nature and non-randomized design, which may introduce selection bias regarding which patients received specific analgesics. Additionally, the sample size (N = 40) was relatively small, which may limit the generalizability of the demographic correlations. Future multi-center randomized trials with larger cohorts are recommended to validate these findings. Conclusion Summary of Findings The results of this prospective observational study demonstrate that the choice of postoperative analgesic technique is a critical determinant of pulmonary recovery following laparoscopic surgery. Epidural analgesia provided the most effective preservation of pulmonary mechanics, characterized by higher postoperative $ FEV_1 $ values, lower incidence of respiratory complications, and significantly shorter hospital stays compared to systemic opioids. While Patient-Controlled Analgesia (PCA) offers improved patient satisfaction and pain control over intermittent IV opioids, it does not completely mitigate the risk of opioid-induced respiratory depression. Clinical Recommendations Based on these findings, it is recommended that clinicians prioritize neuraxial anesthesia, such as epidural analgesia, for patients undergoing laparoscopic procedures, particularly those with pre-existing risk factors for respiratory compromise. In settings where epidural analgesia is not feasible, multimodal opioid-sparing strategies should be employed to minimize the respiratory burden associated with systemic opioids. Recommendations for Future Research Future research should aim to validate these findings through large-scale, multi-center randomized controlled trials to overcome the limitations of small sample sizes and single-center biases. Additionally, researchers should investigate the long-term impact of these analgesic modalities on chronic postsurgical pain and conducting cost-effectiveness analyses to determine if the higher initial resource use of epidural analgesia is offset by the reduction in hospital stay duration. Further studies could also explore the efficacy of newer regional techniques, such as Transversus Abdominis Plane (TAP) blocks, as potential alternatives to epidural analgesia in laparoscopic surgery. Declarations Ethical Approval and Consent to Participate The study was approved by the Parul University Institutional Ethics Committee for Human Research (Approval No. PUIECHR/PIMSR/00/081734/8117). Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for Publication Not applicable. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Mrs. Lopa Patel and Ms. Mercy Allen: Conceptualization, Methodology, Investigation, Data Curation, Writing – Original Draft.Mr. Yellapu Sampreeth Naidu: Conceptualization, Supervision, Project Administration, Writing – Review & Editing.Dr. Hemantkumar Patadia: Supervision, Validation, Writing – Review & Editing.All authors read and approved the final manuscript. Acknowledgement The authors wish to thank the OT staff and administration at Parul Sevashram Hospital for their invaluable support and participation in this study. Data Availability The data that support the findings of this study are available from the corresponding author, Mrs. Lopa Patel, upon reasonable request. The data are not publicly available due to them containing information that could compromise research participant privacy. References Lee SY, Ryu CG, Koo YH, et al. The effect of ultrasound-guided transversus abdominis plane block on pulmonary function in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2022;36:7334–42. Zhang Y, Guo Y, Gong C, Fu J, Chen L. Influence of Transverse Abdominis Plane Block on Intraoperative Diaphragmatic and Respiratory Functions in Patients Receiving Laparoscopic Colorectal Surgery. Ther Clin Risk Manag. 2024;20:413–26. PMID: 39045135; PMCID: PMC11265371. Bablekos GD, Roussou T, Rasmussen T, Vassiliou MP, Behrakis PK. Postoperative changes on pulmonary function after laparoscopic and open cholecystectomy. Hepatogastroenterology 2003 Sep-Oct;50(53):1193–200. PMID: 14571697. Damiani G, Pinnarelli L, Sammarco A, Sommella L, Francucci M, Ricciardi W. (2008). Postoperative Pulmonary Function in Open versus Laparoscopic Cholecystectomy: A Meta-Analysis of the Tiffenau Index. Digestive Surgery, 25(1), 1–7. 10.1159/000114193 Nimmo SM, Foo ITH, Paterson HM. Enhanced recovery after surgery: Pain management. J Surg Oncol. 2017;116(5):583–91. 10.1002/jso.24814 . Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33(3):160–71. 10.1097/eja.0000000000000366 . Palkovic B, Marchenko V, Zuperku EJ, Stuth EAE, Stucke AG. Multi-Level Regulation of Opioid-Induced Respiratory Depression. Physiol (Bethesda). 2020;35(6):391–404. 10.1152/physiol.00015.2020 . PMID: 33052772; PMCID: PMC7864237. Overdyk F, Dahan A, Roozekrans M, der Schrier R, Aarts L, Niesters M. Opioid-induced respiratory depression in the acute care setting: a compendium of case reports. Pain Manage. 2014;4(4):317–25. 10.2217/pmt.14.19 . Pöpping DM. Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery. Arch Surg. 2008;143(10):990. 10.1001/archsurg.143.10.990 . Kee WDN, Lam KK. Respiratory depression associated with patient-controlled analgesia. Can J Anaesth. 1995;42(10):953–4. 10.1007/bf03011050 . Joshi GP, Schug SA, Kehlet H. Procedure-specific pain management and outcome strategies. Best Pract Res Clin Anaesthesiol. 2014;28(2):191–201. 10.1016/j.bpa.2014.03.005 . Etches RC. Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth. 1994;41(2):125–32. 10.1007/bf03009805 . Additional Declarations No competing interests reported. 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12:32:33","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78150,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8520415/v1/8134f4c13a309696683033f4.html"},{"id":100683469,"identity":"9c45bf99-9f3a-4018-9229-97c1ae1cf6bf","added_by":"auto","created_at":"2026-01-20 12:32:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":167959,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA bar chart showing mean length of hospital stay of patients by analgesic techniques\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8520415/v1/e0078f711e3e60dc795fe8bd.png"},{"id":100683471,"identity":"27ca68ae-312f-416b-8944-07fe2b1aa0e1","added_by":"auto","created_at":"2026-01-20 12:32:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53074,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA bar chart showing mean pain score of patients by analgesic technique\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8520415/v1/06b631d3a52cdbf39d266b29.png"},{"id":105034860,"identity":"1bfb6968-c641-4a96-a03f-1c0461e1ef1f","added_by":"auto","created_at":"2026-03-20 07:24:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1374282,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8520415/v1/219f2585-e35e-4e43-87b5-6d2dcbcc0a2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analgesic approaches and their effects on respiratory outcome after laparoscopic surgery: A Prospective Observational Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the last decade, medical centers worldwide have widely adopted laparoscopic surgery as the standard intervention for treating chronic asymptomatic cholecystitis and gallstones. While this minimally invasive approach offers significant benefits, a significant decrease in diaphragmatic activity is often observed immediately following surgery, although patients typically demonstrate rapid recovery by the first postoperative day [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recent findings indicate that compared to open surgery, laparoscopic procedures result in less impairment of lung function and arterial blood gas levels. It is hypothesized that this relative preservation of pulmonary function may correlate with a reduced incidence of postoperative pulmonary complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, intraoperative factors such as patient positioning, carbon dioxide (CO2) insufflation, and diaphragmatic elevation can significantly reduce lung expansion, increase airway pressure, and cause transient hypercapnia and hypoxemia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA comparative analysis of different analgesic techniques is necessary to determine the optimal method that balances effective pain control with minimal impact on pulmonary function. This study evaluates the existing evidence regarding various postoperative analgesic methods and their specific impact on pulmonary mechanics in patients undergoing laparoscopic surgery. By critically evaluating the relationship between pain management practices and respiratory outcomes, this article aims to identify the analgesic approaches that best maintain or enhance postoperative pulmonary function while providing sufficient pain relief [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Gaining an understanding of these physiological connections is crucial for developing clinical recommendations that reduce pulmonary complications, improve patient comfort, and optimize recovery outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough laparoscopic surgery offers advantages such as reduced mortality rates, shorter hospital stays, faster recovery, and decreased postoperative pain, it can still result in significant alterations to respiratory health. Postoperatively, patients may experience declines in forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and functional residual capacity (FRC). These physiological changes can precipitate respiratory complications including atelectasis, pneumonia, tracheobronchial infection, and respiratory failure, all of which contribute to prolonged hospital stays. Multiple factors, including the analgesic technique selected for postoperative pain management, combine to influence this postoperative dysfunction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering the growing emphasis on enhanced recovery protocols, the selection of analgesia\u0026mdash;specifically Intravenous (IV) Opioids, Patient-Controlled Analgesia (PCA), or Epidural Analgesia\u0026mdash;is a critical determinant of postoperative pulmonary outcomes. Each technique impacts effectiveness, side effect profiles, and respiratory physiology differently. Unlike epidural analgesia, which provides localized pain management with minimal systemic influence, intravenous opioids may significantly depress respiratory drive despite providing effective pain relief. PCA allows patients to self-administer analgesia; however, its respiratory effects vary significantly based on usage patterns. It is essential to investigate how these different approaches affect lung function, gas exchange, and the development of pulmonary complications to guide clinical judgment and tailor pain management for optimal recovery.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis prospective observational cohort study was conducted at Parul Sevashram Hospital to assess the comparative effects of different analgesic modalities on postoperative pulmonary outcomes. The study utilized a quantitative non-experimental design to observe patients in a clinical setting without altering their standard surgical or anesthetic care.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles and was approved by the Parul University Institutional Ethics Committee on Human Research (PU-IECHR) (Approval Number: \u003cb\u003ePUIECHR/PIMSR/00/081734/8117\u003c/b\u003e). Written informed consent was obtained from all participants prior to their Enrollment in the study, and they were informed of their right to withdraw at any stage without compromising their care. Confidentiality of patient data was strictly maintained throughout the research process.\u003c/p\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eA purposive sampling technique was employed to recruit a total of 40 patients undergoing elective laparoscopic surgery. Patients were categorized into three groups based on the postoperative analgesic technique prescribed by the attending anesthesiologists:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGroup IV\u003c/b\u003e: Patients receiving Intravenous Opioids (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGroup EA\u003c/b\u003e: Patients receiving Epidural Analgesia (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGroup PCA\u003c/b\u003e: Patients receiving Patient-Controlled Analgesia (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe study included adult patients of both genders undergoing elective laparoscopic procedures who consented to participate. To ensure the validity of respiratory outcome data, strict exclusion criteria were applied. Patients with a history of significant pre-existing pulmonary pathologies, specifically Chronic Obstructive Pulmonary Disease (COPD) or bronchial asthma, were excluded from the study to prevent confounding variables regarding baseline lung function.\u003c/p\u003e\n\u003ch3\u003eData Collection and Outcome Measures\u003c/h3\u003e\n\u003cp\u003eData collection was performed systematically in the postoperative recovery unit. The primary respiratory parameters assessed included Respiratory Rate (RR), Oxygen Saturation (SpO2), and pulmonary function tests, specifically Forced Expiratory Volume in 1 second (FEV_1). Baseline values were recorded preoperatively and compared with postoperative values to determine the degree of respiratory deviation. Secondary outcomes included pain scores assessed using a standard pain scale, the incidence of respiratory complications (e.g., atelectasis, desaturation), and the total length of hospital stay.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were compiled and analysed to evaluate the relationship between the analgesic technique used and postoperative outcomes. Quantitative variables, including respiratory rates and FEV\u003csup\u003e1\u003c/sup\u003e, were expressed as Mean\u0026plusmn;, Standard Deviation (SD). Categorical variables such as the incidence of complications were presented as frequencies and percentages. Comparative analysis was conducted to determine statistical significance between the groups, ensuring a reliable evaluation of the impact of each analgesic method on recovery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Patients by Demographic Variables (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEducational Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlace of Residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic Characteristics\u003c/b\u003e A total of 40 patients undergoing laparoscopic surgery were included in the study. The demographic distribution of the study population is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of participants were male (60%) and married (75%). Regarding age distribution, the largest subgroup was aged 36\u0026ndash;45 years (35%). In terms of residence, 70% of patients resided in urban areas, while 30% were from rural backgrounds. Educational status varied, with 40% of participants having completed tertiary education.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of patients by analgesic technique\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalgesic Technique\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV Opioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural Analgesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDistribution of Analgesic Techniques\u003c/b\u003e Patients were categorized into three groups based on the postoperative analgesic modality administered: Intravenous (IV) Opioids (\u003cspan\u003e$\u003c/span\u003en\u0026thinsp;=\u0026thinsp;15\u003cspan\u003e$\u003c/span\u003e, 37.5%), Patient-Controlled Analgesia (PCA) (\u003cspan\u003e$\u003c/span\u003en\u0026thinsp;=\u0026thinsp;13\u003cspan\u003e$\u003c/span\u003e, 32.5%), and Epidural Analgesia (EA) (\u003cspan\u003e$\u003c/span\u003en\u0026thinsp;=\u0026thinsp;12\u003cspan\u003e$\u003c/span\u003e, 30%). This distribution is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Pre- and Postoperative Respiratory Parameters by Analgesic Technique\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalgesic Technique\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-op Respiratory Rate (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-op Respiratory Rate (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-op FEV1 (% Predicted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-op FEV1 (% Predicted)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV Opioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e97.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e80.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural Analgesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e96.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e88.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e97.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e83.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRespiratory Outcomes and Pulmonary Function\u003c/b\u003e The comparison of preoperative and postoperative respiratory parameters is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Baseline preoperative respiratory rates (RR) and Forced Expiratory Volume in 1 second FEV\u003csup\u003e1\u003c/sup\u003e were comparable across all three groups. Postoperatively, the IV Opioid group exhibited the most significant deviation from baseline, with a mean respiratory rate increasing to 18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 bpm and FEV\u003csup\u003e1\u003c/sup\u003e declining to 80.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5% of the predicted value. The PCA group showed moderate changes (RR: 15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 bpm; FEV1: 83.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9%). The Epidural Analgesia group demonstrated the highest preservation of pulmonary function, with a postoperative FEV\u003csup\u003e1\u003c/sup\u003e of 88.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7% and minimal increase in respiratory rate (14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 bpm).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative Oxygen Requirement and Respiratory Complications by Analgesic Technique\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalgesic Technique\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients Needing Oxygen (n/total)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage Needing Oxygen (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients with Respiratory Complications (n/total)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage with Complications (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV Opioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural Analgesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eOxygen Requirement and Complications\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the incidence of postoperative oxygen requirements and respiratory complications. The IV Opioid group had the highest requirement for supplemental oxygen (53.3%) and the highest incidence of respiratory complications (26.7%). In contrast, the Epidural Analgesia group had the lowest oxygen requirement (16.7%) and complication rate (8.3%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePain Scores and Hospital Stay\u003c/b\u003e Pain intensity and length of hospital stay varied significantly by analgesic technique. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the mean length of hospital stay was longest in the IV Opioid group (3.8 days), followed by the PCA group (3.0 days), and shortest in the Epidural Analgesia group (2.4 days).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding pain management efficacy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the IV Opioid group reported the highest mean pain scores (4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3). The PCA group reported moderate pain scores (3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2), while the Epidural Analgesia group reported the lowest mean pain scores (2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLink between Postoperative Pulmonary Outcomes and Demographic Factors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEV1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMales had significantly lower FEV1 than females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Requirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMales required oxygen more than females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMore complications in males than female\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEV1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant across age groups\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Requirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of Residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFEV1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRural patients had lower FEV1 than urban\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRural patients had longer hospital stays\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMore complications in rural patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAssociation Between Demographic Variables and Outcomes\u003c/b\u003e The impact of demographic factors on postoperative outcomes was analysed using Chi-square tests (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Gender showed a statistically significant association with FEV_1 (p\u0026thinsp;=\u0026thinsp;0.036), oxygen requirement (p\u0026thinsp;=\u0026thinsp;0.013), and complication rates (p\u0026thinsp;=\u0026thinsp;0.015), with male patients exhibiting lower FEV_1 and higher complication rates compared to females. Place of residence was also significantly associated with clinical outcomes; patients from rural areas had significantly lower FEV_1 (p\u0026thinsp;=\u0026thinsp;0.026), higher complication rates (p\u0026thinsp;=\u0026thinsp;0.023), and longer hospital stays (p\u0026thinsp;=\u0026thinsp;0.012) compared to urban residents. Age, marital status, educational status, and occupation did not show statistically significant correlations with respiratory outcomes or length of hospital stay (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion of results","content":"\u003cp\u003eThis prospective observational study evaluated the impact of three distinct analgesic modalities\u0026mdash;Intravenous (IV) Opioids, Patient-Controlled Analgesia (PCA), and Epidural Analgesia (EA)\u0026mdash;on postoperative pulmonary function and respiratory outcomes following laparoscopic surgery. The principal finding of this study is that Epidural Analgesia significantly preserves postoperative lung function, as evidenced by higher FEV\u003csup\u003e1\u003c/sup\u003e values, reduced oxygen requirements, and shorter hospital stays compared to systemic opioid-based regimens. Conversely, IV opioids were associated with the most profound respiratory depression and the highest incidence of pulmonary complications.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImpact of Analgesia on Pulmonary Mechanics\u003c/h2\u003e \u003cp\u003eLaparoscopic surgery, despite being minimally invasive, induces temporary diaphragmatic dysfunction and alters pulmonary mechanics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Our results indicated that patients receiving IV opioids experienced a significant decline in FEV\u003csup\u003e1\u003c/sup\u003e (80.2% of predicted) and a high rate of supplemental oxygen dependence (53.3%). This aligns with the physiological mechanisms described by Palkovic et al., who highlighted that systemic opioids act on mu-opioid receptors in the brainstem to depress respiratory drive and reduce tidal volume [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, the sedative effects of bolus IV opioids often discourage deep breathing and early mobilization, exacerbating atelectasis. This finding corroborates the work of Overdyk et al., who identified opioid-induced respiratory depression (OIRD) as a significant, often underreported hazard in acute care settings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSuperiority of Epidural Analgesia\u003c/h2\u003e \u003cp\u003eIn contrast to systemic opioids, the Epidural Analgesia group demonstrated superior preservation of pulmonary function (FEV\u003csup\u003e1\u003c/sup\u003e 88.1%) and the lowest pain scores (2.7 1.1). This accords with the meta-analysis by P\u0026ouml;pping et al., which established that epidural analgesia reduces the odds of pneumonia and respiratory failure after abdominal surgery by providing potent, segmental analgesia without central nervous system depression [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. By effectively blocking nociceptive input, epidural analgesia allows patients to cough and breathe deeply without pain-induced splinting. Our data supports the conclusion that epidural techniques are integral to Enhanced Recovery After Surgery (ERAS) protocols, as suggested by Nimmo et al., facilitating earlier mobilization and reduced hospital stays (2.4 days in our EA group) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe Role of Patient-Controlled Analgesia (PCA)\u003c/h2\u003e \u003cp\u003eOur study observed that PCA offered intermediate results between IV opioids and EA. While PCA provided better pain control and patient satisfaction than nurse-administered IV opioids, it was still associated with a moderate decline in FEV\u003csup\u003e1\u003c/sup\u003e (83.9%) and a 30.8% oxygen requirement. This reflects the \"double-edged\" nature of PCA described by Kee and Lam; while self-titration reduces the risk of massive overdose compared to large boluses, the cumulative dose of opioids still poses a risk for respiratory depression, particularly during sleep [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Etches et al. similarly noted that while PCA improves comfort, it does not eliminate the risk of hypoventilation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, while PCA is preferable to intermittent IV boluses, it remains inferior to epidural analgesia regarding pulmonary preservation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Influences on Respiratory Outcomes\u003c/h2\u003e \u003cp\u003eWe identified that male gender and rural residence were associated with poorer respiratory outcomes. The correlation between male gender and lower FEV\u003csup\u003e1\u003c/sup\u003e may be attributed to differences in body fat distribution and diaphragmatic mechanics, as noted in studies on post-laparoscopic pulmonary function [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The disparity in outcomes based on residence may reflect preoperative health literacy or delayed presentation for surgery, although this requires further investigation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThe choice of analgesic technique is not merely a matter of comfort but a critical determinant of respiratory safety. As emphasized by Joshi et al., procedure-specific pain management is essential for improving outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our findings suggest that for patients at high risk of respiratory complications, or those undergoing prolonged laparoscopic procedures, epidural analgesia should be the preferred modality. For patients where neuraxial anesthesia is contraindicated, multimodal analgesia with reduced opioid reliance should be prioritized to mitigate the risks of respiratory depression detailed by Rawal [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was limited by its observational nature and non-randomized design, which may introduce selection bias regarding which patients received specific analgesics. Additionally, the sample size (N\u0026thinsp;=\u0026thinsp;40) was relatively small, which may limit the generalizability of the demographic correlations. Future multi-center randomized trials with larger cohorts are recommended to validate these findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSummary of Findings\u003c/h2\u003e \u003cp\u003eThe results of this prospective observational study demonstrate that the choice of postoperative analgesic technique is a critical determinant of pulmonary recovery following laparoscopic surgery. Epidural analgesia provided the most effective preservation of pulmonary mechanics, characterized by higher postoperative \u003cspan\u003e$\u003c/span\u003eFEV_1\u003cspan\u003e$\u003c/span\u003e values, lower incidence of respiratory complications, and significantly shorter hospital stays compared to systemic opioids. While Patient-Controlled Analgesia (PCA) offers improved patient satisfaction and pain control over intermittent IV opioids, it does not completely mitigate the risk of opioid-induced respiratory depression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eClinical Recommendations\u003c/h2\u003e \u003cp\u003eBased on these findings, it is recommended that clinicians prioritize neuraxial anesthesia, such as epidural analgesia, for patients undergoing laparoscopic procedures, particularly those with pre-existing risk factors for respiratory compromise. In settings where epidural analgesia is not feasible, multimodal opioid-sparing strategies should be employed to minimize the respiratory burden associated with systemic opioids.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for Future Research\u003c/h2\u003e \u003cp\u003eFuture research should aim to validate these findings through large-scale, multi-center randomized controlled trials to overcome the limitations of small sample sizes and single-center biases. Additionally, researchers should investigate the long-term impact of these analgesic modalities on chronic postsurgical pain and conducting cost-effectiveness analyses to determine if the higher initial resource use of epidural analgesia is offset by the reduction in hospital stay duration. Further studies could also explore the efficacy of newer regional techniques, such as Transversus Abdominis Plane (TAP) blocks, as potential alternatives to epidural analgesia in laparoscopic surgery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003eThe study was approved by the Parul University Institutional Ethics Committee for Human Research (Approval No. PUIECHR/PIMSR/00/081734/8117). Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMrs. Lopa Patel and Ms. Mercy Allen: Conceptualization, Methodology, Investigation, Data Curation, Writing \u0026ndash; Original Draft.Mr. Yellapu Sampreeth Naidu: Conceptualization, Supervision, Project Administration, Writing \u0026ndash; Review \u0026amp; Editing.Dr. Hemantkumar Patadia: Supervision, Validation, Writing \u0026ndash; Review \u0026amp; Editing.All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors wish to thank the OT staff and administration at Parul Sevashram Hospital for their invaluable support and participation in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, Mrs. Lopa Patel, upon reasonable request. The data are not publicly available due to them containing information that could compromise research participant privacy.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLee SY, Ryu CG, Koo YH, et al. The effect of ultrasound-guided transversus abdominis plane block on pulmonary function in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2022;36:7334\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Guo Y, Gong C, Fu J, Chen L. Influence of Transverse Abdominis Plane Block on Intraoperative Diaphragmatic and Respiratory Functions in Patients Receiving Laparoscopic Colorectal Surgery. Ther Clin Risk Manag. 2024;20:413\u0026ndash;26. PMID: 39045135; PMCID: PMC11265371.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBablekos GD, Roussou T, Rasmussen T, Vassiliou MP, Behrakis PK. Postoperative changes on pulmonary function after laparoscopic and open cholecystectomy. Hepatogastroenterology 2003 Sep-Oct;50(53):1193\u0026ndash;200. PMID: 14571697.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamiani G, Pinnarelli L, Sammarco A, Sommella L, Francucci M, Ricciardi W. (2008). \u003cem\u003ePostoperative Pulmonary Function in Open versus Laparoscopic Cholecystectomy: A Meta-Analysis of the Tiffenau Index. Digestive Surgery, 25(1), 1\u0026ndash;7.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000114193\u003c/span\u003e\u003cspan address=\"10.1159/000114193\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNimmo SM, Foo ITH, Paterson HM. Enhanced recovery after surgery: Pain management. J Surg Oncol. 2017;116(5):583\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jso.24814\u003c/span\u003e\u003cspan address=\"10.1002/jso.24814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33(3):160\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/eja.0000000000000366\u003c/span\u003e\u003cspan address=\"10.1097/eja.0000000000000366\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalkovic B, Marchenko V, Zuperku EJ, Stuth EAE, Stucke AG. Multi-Level Regulation of Opioid-Induced Respiratory Depression. 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Can J Anaesth. 1994;41(2):125\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/bf03009805\u003c/span\u003e\u003cspan address=\"10.1007/bf03009805\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Epidural analgesia, Intravenous opioids, Laparoscopic surgery, Patient-controlled analgesia, Postoperative analgesia, Pulmonary function","lastPublishedDoi":"10.21203/rs.3.rs-8520415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8520415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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\u0026thinsp;=\u0026thinsp;15), EA (n\u0026thinsp;=\u0026thinsp;12), and PCA (n\u0026thinsp;=\u0026thinsp;13). Primary outcomes included postoperative Forced Expiratory Volume in 1 second (FEV\u003csup\u003e1\u003c/sup\u003e), respiratory rate, and oxygen saturation (SpO\u003csub\u003e2\u003c/sub\u003e). Secondary outcomes included pain scores, incidence of respiratory complications, and length of hospital stay.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe IV opioid group exhibited the most significant postoperative decline in FEV\u003csup\u003e1\u003c/sup\u003e (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\u003csup\u003e1\u003c/sup\u003e post-op: 88.1%) and the lowest incidence of respiratory complications (8.3%). Patients receiving EA reported significantly lower mean pain scores (2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1) compared to the IV opioid (4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3) and PCA (3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2) groups. Consequently, the EA group had the shortest mean hospital stay (2.4 days) compared to IV opioids (3.8 days).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEpidural 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.\u003c/p\u003e","manuscriptTitle":"Analgesic approaches and their effects on respiratory outcome after laparoscopic surgery: A Prospective Observational Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 10:40:10","doi":"10.21203/rs.3.rs-8520415/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75ab3527-fe59-462a-af23-e03420ec47b0","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T07:56:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 10:40:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8520415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8520415","identity":"rs-8520415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}