{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:12:02Z","timestamp":1774620722311,"version":"3.50.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Perioper Med"],"DOI":"10.1186\/s13741-026-00654-9","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:17:24Z","timestamp":1771651044000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined epidural\u2013general anesthesia reduces opioid use and improves recovery after laparoscopic hysterectomy: a retrospective cohort study"],"prefix":"10.1186","volume":"15","author":[{"given":"Shufen","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Songquan","family":"Kong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianqian","family":"Fang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"issue":"9","key":"654_CR1","first-page":"e92682","volume":"17","author":"A Ahmed","year":"2025","unstructured":"Ahmed A, Amjad A. Comparison of opioid-based and multimodal analgesic regimens for postoperative pain management in gynecological surgery. Cureus. 2025;17(9):e92682.","journal-title":"Cureus"},{"issue":"1","key":"654_CR2","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.ygyno.2020.12.035","volume":"161","author":"SP Bisch","year":"2021","unstructured":"Bisch SP, Jago CA, Kalogera E, Ganshorn H, Meyer LA, Ramirez PT, et al. Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology - a systematic review and meta-analysis. Gynecol Oncol. 2021;161(1):46\u201355.","journal-title":"Gynecol Oncol"},{"key":"654_CR4","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.2147\/JPR.S373412","volume":"15","author":"H Choi","year":"2022","unstructured":"Choi H, Song JY, Oh EJ, Chae MS, Yu S, Moon YE. The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: a prospective randomized controlled trial. J Pain Res. 2022;15:2197\u2013209.","journal-title":"J Pain Res"},{"key":"654_CR3","doi-asserted-by":"crossref","unstructured":"Cho S, Bang H, Shin S, Kim H, Park S, Lee PS, Lee EE. Opioid-associated postoperative nausea and vomiting in women undergoing laparoscopic hysterectomy: a network meta-analysis. Medicina (Kaunas). 2025;61(10):1728.","DOI":"10.3390\/medicina61101728"},{"key":"654_CR5","doi-asserted-by":"crossref","unstructured":"Cozowicz C, Gerner HD, Zhong H, Illescas A, Reisinger L, Poeran J, Liu J, Memtsoudis SG. Multimodal analgesia and outcomes in hysterectomy surgery-a population-based analysis. J Clin Med. 2024;13(18):5431.","DOI":"10.3390\/jcm13185431"},{"issue":"6","key":"654_CR6","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1007\/s00404-024-07469-3","volume":"309","author":"C Erkan","year":"2024","unstructured":"Erkan C, Inal HA, Uysal A. Intra- and post-operative outcomes of the enhanced recovery after surgery (ERAS) program in laparoscopic hysterectomy. Arch Gynecol Obstet. 2024;309(6):2751\u20139.","journal-title":"Arch Gynecol Obstet"},{"issue":"1","key":"654_CR7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12871-021-01399-2","volume":"21","author":"Z Geng","year":"2021","unstructured":"Geng Z, Bi H, Zhang D, Xiao C, Song H, Feng Y, et al. The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial. BMC Anesthesiol. 2021;21(1):179.","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"654_CR8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12871-023-01981-w","volume":"23","author":"ZY Geng","year":"2023","unstructured":"Geng ZY, Zhang Y, Bi H, Zhang D, Li Z, Jiang L, et al. Addition of preoperative transversus abdominis plane block to multimodal analgesia in open gynecological surgery: a randomized controlled trial. BMC Anesthesiol. 2023;23(1):21.","journal-title":"BMC Anesthesiol"},{"issue":"4","key":"654_CR9","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1097\/GCO.0000000000000634","volume":"32","author":"CM Helou","year":"2020","unstructured":"Helou CM, Chaves KF, Limperg TB, Anderson TL. Enhanced recovery after surgery in minimally invasive gynecologic surgery surgical patients: one size fits all? Curr Opin Obstet Gynecol. 2020;32(4):248\u201354.","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"1","key":"654_CR10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ajog.2022.12.015","volume":"229","author":"K Hessami","year":"2023","unstructured":"Hessami K, Welch J, Frost A, AlAshqar A, Arian SE, Gough E, et al. Perioperative opioid dispensing and persistent use after benign hysterectomy: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;229(1):23-32.e23.","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"654_CR11","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.bja.2024.04.044","volume":"133","author":"DW Hewson","year":"2024","unstructured":"Hewson DW, Tedore TR, Hardman JG. Impact of spinal or epidural anaesthesia on perioperative outcomes in adult noncardiac surgery: a narrative review of recent evidence. Br J Anaesth. 2024;133(2):380\u201399.","journal-title":"Br J Anaesth"},{"issue":"1","key":"654_CR12","doi-asserted-by":"publisher","first-page":"11759","DOI":"10.1038\/s41598-024-62824-3","volume":"14","author":"Y Hu","year":"2024","unstructured":"Hu Y, Zhang QY, Qin GC, Zhu GH, Long X, Xu JF, et al. Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial. Sci Rep. 2024;14(1):11759.","journal-title":"Sci Rep"},{"key":"654_CR13","doi-asserted-by":"crossref","unstructured":"Hwang JH, Kim BW. Comparison of general anesthesia and combined spinal and epidural anesthesia for gasless laparoscopic surgery in gynecology. JSLS. 2022;26(2):e2022.00004.","DOI":"10.4293\/JSLS.2022.00004"},{"issue":"3","key":"654_CR14","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1002\/ijgo.13382","volume":"151","author":"O Kilpi\u00f6","year":"2020","unstructured":"Kilpi\u00f6 O, H\u00e4rkki PSM, Mentula MJ, V\u00e4\u00e4n\u00e4nen A, Pakarinen PI. Recovery after enhanced versus conventional care laparoscopic hysterectomy performed in the afternoon: a randomized controlled trial. Int J Gynaecol Obstet. 2020;151(3):392\u20138.","journal-title":"Int J Gynaecol Obstet"},{"issue":"8","key":"654_CR15","first-page":"e91339","volume":"17","author":"F Lasanta Gorbea","year":"2025","unstructured":"Lasanta Gorbea F, Limardo A, Valentin S, Ojeda F, Torres J, Ramirez-Rivera F. Incorporating transversus abdominis plane block in hysterectomy anesthesia: clinical outcomes in a Hispanic population. Cureus. 2025;17(8):e91339.","journal-title":"Cureus"},{"issue":"4","key":"654_CR16","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1136\/rapm-2018-100024","volume":"44","author":"P Lirk","year":"2019","unstructured":"Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019;44(4):425\u201336.","journal-title":"Reg Anesth Pain Med"},{"issue":"5","key":"654_CR17","first-page":"5294","volume":"13","author":"Y Liu","year":"2021","unstructured":"Liu Y, He S, Zhou S. Effect of general anesthesia combined with epidural anesthesia on circulation and stress response of patients undergoing hysterectomy. Am J Transl Res. 2021;13(5):5294\u2013300.","journal-title":"Am J Transl Res"},{"issue":"6","key":"654_CR18","doi-asserted-by":"publisher","first-page":"605","DOI":"10.4097\/kja.24336","volume":"77","author":"SW Nam","year":"2024","unstructured":"Nam SW, Do SH, Hwang JW, Park I, Hwang I, Na HS. Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery. Korean J Anesthesiol. 2024;77(6):605\u201313.","journal-title":"Korean J Anesthesiol"},{"issue":"1","key":"654_CR19","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s00404-024-07475-5","volume":"310","author":"J Nian","year":"2024","unstructured":"Nian J, Li Z, Chen P, Ye P, Liu C. Enhanced recovery after surgery versus conventional postoperative care in patients undergoing hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024;310(1):515\u201324.","journal-title":"Arch Gynecol Obstet"},{"issue":"5","key":"654_CR20","first-page":"e84814","volume":"17","author":"EF Ortiz Vazquez","year":"2025","unstructured":"Ortiz Vazquez EF, Londo\u00f1o Victoria JC, Castillo L\u00f3pez GA, Hidalgo Tapia EC, Mena Acosta FI, Puchaicela Namcela SDR. Minimally invasive gynecologic surgery and enhanced recovery and outcomes: a literature review. Cureus. 2025;17(5):e84814.","journal-title":"Cureus"},{"issue":"3","key":"654_CR21","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.bja.2022.05.029","volume":"129","author":"K Pirie","year":"2022","unstructured":"Pirie K, Traer E, Finniss D, Myles PS, Riedel B. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. Br J Anaesth. 2022;129(3):378\u201393.","journal-title":"Br J Anaesth"},{"key":"654_CR22","doi-asserted-by":"publisher","first-page":"1606383","DOI":"10.3389\/fmed.2025.1606383","volume":"12","author":"Y Shen","year":"2025","unstructured":"Shen Y, Wu Y, Tang Q, Wang Y, Ma W, Wang J. Efficacy of opioid-free anesthesia in reducing postoperative nausea and vomiting following gynecological laparoscopic surgery: a randomized controlled trial. Front Med (Lausanne). 2025;12:1606383.","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"654_CR23","doi-asserted-by":"publisher","first-page":"112","DOI":"10.4103\/jmas.jmas_42_22","volume":"19","author":"R Sinha","year":"2023","unstructured":"Sinha R, Verma N, Bana R, Kalidindi N, Sampurna S, Mohanty GS. Intra- and post-operative outcomes in benign gynaecologic surgeries before and after the implementation of enhanced recovery after surgery protocols: a comparison. J Minim Access Surg. 2023;19(1):112\u20139.","journal-title":"J Minim Access Surg"},{"issue":"1","key":"654_CR24","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1186\/s12871-025-03252-2","volume":"25","author":"MG Taflan","year":"2025","unstructured":"Taflan MG, Akdeniz S, Kusderci H, Arslan K, \u00dcnal M, S\u00fcren M, et al. Comparison of combined spinal-epidural versus general anesthesia with epidural catheter on postoperative quality of recovery after abdominal hysterectomy: a prospective observational study. BMC Anesthesiol. 2025;25(1):386.","journal-title":"BMC Anesthesiol"},{"key":"654_CR25","doi-asserted-by":"publisher","first-page":"1330250","DOI":"10.3389\/fphar.2023.1330250","volume":"14","author":"Z Zhang","year":"2023","unstructured":"Zhang Z, Li C, Xu L, Sun X, Lin X, Wei P, et al. Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis. Front Pharmacol. 2023;14:1330250.","journal-title":"Front Pharmacol"}],"container-title":["Perioperative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13741-026-00654-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-026-00654-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-026-00654-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:07:05Z","timestamp":1774616825000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13741-026-00654-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,21]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["654"],"URL":"https:\/\/doi.org\/10.1186\/s13741-026-00654-9","relation":{},"ISSN":["2047-0525"],"issn-type":[{"value":"2047-0525","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,21]]},"assertion":[{"value":"17 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the Ethics Committee of Panan County People\u2019s Hospital. Given the retrospective design and use of de-identified data, the requirement for written informed consent was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. This manuscript does not contain identifiable individual-level data, images, or videos.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}