Impact of Combined Epidural–General Anesthesia on Perioperative Recovery After Hepatectomy for Liver Cancer: A Prospective Observational Study

Background: Optimizing anesthetic strategies may improve perioperative recovery and cognitive outcomes in patients undergoing hepatectomy. However, evidence comparing general anesthesia (GA) and combined epidural–general anesthesia (GEA) remains limited. Methods: This prospective observational study included 106 patients undergoing elective hepatectomy, allocated to GA (n = 59) or GEA (n = 47) based on patient preference following standardized anesthetic consultation. Pain was assessed using the Visual Analog Scale (VAS), and cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline and postoperative days 1 and 3. Outcome assessors were blinded to group allocation. Intraoperative remifentanil dosage was normalized (μg/kg/min), and group comparisons were performed using appropriate parametric or non-parametric tests. Results: Compared with the GEA group, the GA group had higher normalized remifentanil requirements (0.308 ± 0.040 vs. 0.294 ± 0.032 μg/kg/min, 95% CI 0.001– 0.028, P = 0.042) and higher postoperative VAS scores at 24 h (median 3 vs. 2, 95% CI 0.61– 0.79, P < 0.001). The GA group also showed lower MoCA scores on postoperative day 1 (median 24 vs. 26, P < 0.001) and longer hospital stay (20.24 ± 3.05 vs. 15.83 ± 1.92 days, P < 0.001). The incidence of adverse events was higher in the GA group (20.34% vs. 6.38%, P = 0.041). Conclusion: In this prospective observational study, combined epidural–general anesthesia was associated with improved postoperative pain control and early cognitive outcomes. However, given the non-randomized design, causal relationships cannot be established, and further randomized studies are warranted.