AB152. SOH26AB_0295. Neuraxial anaesthesia without general anaesthesia for major colorectal surgery: a systematic review of feasibility, safety, and post-operative outcomes

Background: Colorectal surgery is frequently performed in older, co-morbid patients at increased cardiopulmonary risk under general anaesthesia (GA). Neuraxial anaesthesia with spontaneous ventilation may mitigate these risks, but evidence is fragmented. We summarised the feasibility, safety, and postoperative outcomes of neuraxial anaesthesia without routine GA for major colorectal surgery.

Methods: PubMed, Embase, Cochrane, and Web of Science were searched to identify major colorectal resections performed under spinal, epidural, or combined spinal-epidural anaesthesia with spontaneous ventilation. Comparative and non-comparative studies were included. Primary outcomes were feasibility (completion without conversion to GA) and major complications or mortality; secondary outcomes included respiratory function, length of stay, intensive care unit (ICU) admission, pain, opioid use, and bowel recovery.

Results: Across studies, neuraxial anaesthesia was successfully used for open and minimally invasive colorectal surgery, often in frail or high-risk patients. Comparative studies showed similar complications, mortality, stay, and bowel recovery to GA, with signals of benefit for blood loss, respiratory function, and in some series, operative time. Non-comparative series reported acceptable haemodynamic stability, low ICU utilisation, and favourable patient experience.

Conclusions: Existing literature suggests neuraxial anaesthesia without routine GA is feasible for selected major colorectal surgery, with reassuring short-term safety and recovery. Larger comparative studies are needed to define patient selection and quantify benefits versus risks.

Keywords: Colorectal surgery; epidural anaesthesia; neuraxial anaesthesia; post-operative outcomes; spinal anaesthesia