Background: Advanced endometriosis is a complex, estrogen-dependent inflammatory condition often requiring prolonged and technically demanding laparoscopic surgery. Perioperative anaesthetic management in women with moderate to severe disease is challenging due to altered pain processing, extensive adhesions, and physiological changes associated with pneumoperitoneum. Prospective data evaluating anaesthetic characteristics, postoperative pain trajectories, and early recovery outcomes in this population remain limited.

Methods: This prospective observational study included 30 women aged 18–45 years with surgically confirmed revised American Society for Reproductive Medicine (rASRM) stage III–IV endometriosis undergoing elective laparoscopic surgery. All patients were classified as American Society of Anesthesiologists (ASA) physical status I–II and received a standardized general anaesthesia protocol. Intraoperative parameters, including duration of anaesthesia, pneumoperitoneum time, blood loss, and recovery time, were recorded. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at predefined intervals up to 24 hours. Analgesic consumption, adverse events, and early recovery parameters were also evaluated.

Results: The mean age of participants was 32 ± 8.6 years, with the majority presenting with significant pain symptoms and infertility. The mean duration of anaesthesia was 125 ± 25 minutes, with minimal blood loss (65 ± 30 mL) and prompt recovery from anaesthesia (18 ± 4 minutes). Postoperative pain scores demonstrated a progressive decline from 4.8 ± 1.2 at 30 minutes to 2.1 ± 0.6 at 24 hours. Multimodal analgesia provided effective pain control, with rescue opioid analgesia required in 30% of patients. Postoperative adverse events were infrequent and mild. Early ambulation, resumption of oral intake, and short hospital stay indicated favorable early recovery outcomes.

Conclusion: A standardized general anaesthesia protocol combined with multimodal analgesia offers effective perioperative stability, satisfactory postoperative pain control, and rapid recovery in women undergoing laparoscopic surgery for moderate to severe endometriosis. These findings support the feasibility and safety of structured perioperative strategies in managing advanced
endometriosis and highlight the need for larger studies to further refine anaesthetic and analgesic protocols in this population.