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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 10 December 2026 | Viewed by 5049

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Special Issue Editors

Prof. Dr. Diana Cimpoesu

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Guest Editor

Emergency Department, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania
Interests: CPR; critical cardiac care; sepsis; trauma; POCUS; point of care biomarkers; emergency intervention, ECMO
Special Issues, Collections and Topics in MDPI journals

Dr. Ovidiu-Horea Bedreag

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Guest Editor

University Clinic of Anaesthesia and Intensive Care, Department X Surgery II, “Victor Babes” University of Medicine and Pharmacy, 3000041 Timisoara, Romania
Interests: anesthesia; intensive care; CRRT; medical teaching; quality improvement management and guidelines

Dr. Mihai Octavian Botea

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Guest Editor Assistant

Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
Interests: perioperative anesthesia; regional anesthesia; pain medicine; emergency medicine; medical simulation

Special Issue Information

Dear Colleagues,

Anesthesiology is an important branch of medicine dedicated to the relief of pain and total care of surgical patients before, during, and after surgery. It encompasses general anesthesia, regional anesthesia, sedation, and pain management, ensuring patient comfort and safety.

Resuscitation involves restoring vital functions in a patient experiencing cardio-respiratory arrest.

Pain management refers to medical practices aimed at reducing or eliminating pain, whether acute, chronic, or cancer-related. It encompasses pharmacological treatments, interventional procedures, physical therapy, and psychological support, and many more forms of assistance.

These three fields are interconnected and closely linked:

Anesthesiology often manages perioperative pain and critical care.
Resuscitation skills are essential in anesthesiology and emergency settings.
Pain management grew out of anesthesiology and overlaps with palliative care, neurology, and rehabilitation.

The disciplines of anesthesiology, resuscitation, and pain management have evolved over the last years to become sophisticated, evidence-based medical specialties. Together, they represent a cornerstone of patient care in both acute and chronic settings, aiming to enhance survival, comfort, and quality of life.

The aim and scope of this Special Issue is to support research in the field by providing a context where the experts and authors can present their opinion and their research results.

This Special Issue will focus on cutting-edge research, with a preference for studies or investigations that are at the forefront of scientific or technological advancement. In particular, we welcome research that

Explores new, innovative ideas or methods;
Pushes the boundaries of current knowledge;
Often involves advanced technologies, novel theories, or experimental techniques;
May lead to breakthrough discoveries or new applications in a field.

We are soliciting original research papers, systematic reviews, and clinical studies that contribute to the advancement of knowledge and practice in the fields of anesthesiology, resuscitation, and pain medicine.

This Special Issue will consider the following domains:

Anesthesiology

Innovations in general, regional, and local anesthesia.
Perioperative monitoring and management.
Anesthesia in special populations (pediatrics, geriatrics, obstetrics).
AI and machine learning applications in anesthetic practice.
Safety and risk reduction in anesthesia.

Resuscitation

Advances in basic and advanced life support.
Technologies in cardiac arrest response (e.g., AEDs, wearable monitors, ECMO).
Post-resuscitation care and neurological outcomes.
Simulation-based training and education in resuscitation.
Public health and community-based CPR interventions.

Pain Management

Pharmacological and non-pharmacological pain therapies.
Chronic and cancer pain management strategies.
Interventional pain techniques (e.g., nerve blocks, spinal cord stimulation).
Multidisciplinary approaches and rehabilitation.
Opioid stewardship and alternatives.

Prof. Dr. Diana Cimpoesu
Dr. Ovidiu-Horea Bedreag
Guest Editors

Dr. Mihai Octavian Botea
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

anesthesiology
resuscitation
pain medicine
general anesthesia
regional anesthesia
emergency medicine
perioperative anesthesia

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Published Papers (6 papers)

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Research

9 pages, 658 KB

Open AccessArticle

Effect of an Intravenous Acetaminophen/Ibuprofen Fixed-Dose Combination on Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Pilot Study

by Hwang-Ju You, Ji-Yoon Jung, Woojin Kwon, Sung-Ae Cho and Tae-Yun Sung

Medicina 2026, 62(6), 1038; https://doi.org/10.3390/medicina62061038 - 27 May 2026

Viewed by 109

Abstract

Background and Objectives: Catheter-related bladder discomfort (CRBD) commonly arises as a direct consequence of perioperative urinary catheterization. A fixed-dose combination of 1000 mg acetaminophen and 300 mg ibuprofen provides multimodal analgesia. In this study, we assessed the impact of this fixed-dose combination on mitigating CRBD in patients undergoing urological procedures. Materials and Methods: In this prospective pilot study, 23 patients undergoing urological surgery requiring urinary catheterization were randomized into two groups; approximately 20 min before the anticipated end of surgery, patients were administered a combination of 1000 mg acetaminophen and 300 mg ibuprofen (intervention group, n = 11) or saline (control group, n = 12). The primary endpoint was the incidence of CRBD immediately after the patient’s arrival at the post-anesthetic care unit (PACU). The incidence of CRBD at 1, 2, and 6 h postoperatively and the severity of CRBD at each time point were also assessed. Results: The incidence of CRBD immediately after arrival at the PACU was lower in the intervention group (54.5% vs. 100%, p = 0.014). However, no significant differences in overall CRBD incidence were observed at later postoperative time points. The incidence of moderate CRBD was lower in the intervention group at 0 h and 1 h (p = 0.036 and 0.037, respectively). Conclusions: The findings of this pilot randomized trial provide preliminary evidence that intravenous acetaminophen and ibuprofen may reduce early postoperative CRBD following urological surgery. Given the small sample size and single-center design, larger multicenter randomized studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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10 pages, 407 KB

Open AccessArticle

Incidence of Clinically Documented Phantom Limb Pain During Hospitalization and Preoperative Risk Factors in Patients Who Underwent Nontraumatic Major Lower Limb Amputation: A Single-Center, Retrospective Study

by Tsutomu Mieda, Hideyuki Asaka, Takumi Yamaguchi, Yohei Kawasaki, Yuta Horikoshi, Tina Nakamura, Asako Tominaga, Hiroshi Hoshijima, Hiroshi Nagasaka, Noritaka Imamachi and Tatsuo Yamamoto

Medicina 2026, 62(5), 848; https://doi.org/10.3390/medicina62050848 - 29 Apr 2026

Viewed by 319

Abstract

Background and Objectives: Phantom limb pain (PLP) frequently occurs after lower limb amputation (LLA). However, a consensus has not been reached regarding its incidence, particularly in nontraumatic amputations, because reported estimates vary according to case mix, follow-up duration, and outcome definitions. Data from Japan remain limited. Methods: After approval by the Institutional Review Board, the electronic medical records of patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) at Saitama Medical University Hospital between 1 January 2012 and 31 December 2024 were retrospectively reviewed. The primary outcome was the incidence of clinically documented PLP during hospitalization, typically within approximately 1–2 months after amputation. PLP was defined as a painful sensation in the amputated limb documented in the medical record and diagnosed by surgeons or anesthesiologists. Postamputation pain due to symptomatic neuroma was not classified as PLP. Patients with only nonpainful phantom limb sensations were not considered to have the primary outcome. Patients aged 18 years or older who required nontraumatic AKA or BKA were included. Patients who (1) died within 30 days of surgery or (2) were unable to communicate were excluded. Results: Clinically documented PLP occurred in 31 of 298 patients (10.4%; exact 95% CI, 7.2–14.4%) during hospitalization. In the prespecified primary model including age and preoperative pain, younger age (adjusted odds ratio (OR) 0.96 per 1-year increase, 95% confidence interval (CI) 0.93–0.99; p = 0.008) and preoperative pain (adjusted OR 16.34, 95% CI 3.75–71.24; p < 0.001) were associated with PLP. In an exploratory model additionally including postoperative pain on the day of surgery, postoperative pain was not independently associated with PLP. Firth penalized logistic regression yielded similar results. Conclusions: This study found a 10.4% incidence of clinically documented PLP during hospitalization after nontraumatic major LLA. Younger age and preoperative pain were associated with PLP, although the estimates should be interpreted cautiously because only 31 PLP events occurred. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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22 pages, 984 KB

Open AccessArticle

Sequence-Dependent Analgesic Efficacy of Ketamine and Magnesium Sulfate After Radical Nephrectomy

by Nikola N. Ladjevic, Zoran Dzamic, Vesna D. Jovanovic, Natasa Dj. Petrovic, Svetlana D. Sreckovic, Milos M. Lazic, Branka Terzic, Ivana Likic Ladjevic and Nebojsa Ladjevic

Medicina 2026, 62(4), 754; https://doi.org/10.3390/medicina62040754 - 15 Apr 2026

Viewed by 539

Abstract

Background and Objectives: Ketamine and magnesium sulfate (MgSO₄) are NMDA receptor antagonists that act through distinct mechanisms. Preclinical data indicate that their analgesic interaction is sequence-dependent: ketamine administered before MgSO₄ produces synergistic antinociception, whereas the reversed sequence is antagonistic. The primary outcomes were postoperative pain intensity (Numerical Rating Scale, NRS 0–10, at rest and on movement) and cumulative intravenous morphine consumption over 48 h, evaluated in patients undergoing open radical nephrectomy to test the hypothesis of sequence-dependent analgesic interaction. Materials and Methods: In this randomized, double-blind, placebo-controlled trial, 208 patients scheduled for elective open radical nephrectomy received two sequential intravenous boluses intraoperatively: Drug A immediately after induction, Drug B 10 min later. Agents were ketamine 0.2 mg/kg, MgSO₄ 15 mg/kg, or placebo (0.9% NaCl) in all nine possible combinations. Primary outcomes were postoperative pain intensity (NRS 0–10, at rest and on movement) and cumulative intravenous morphine consumption, assessed at 14 time points over 48 h. Secondary outcomes included sedation, nausea, vomiting, and the presence of hallucinations. Results: The ketamine → MgSO₄ (K → Mg) sequence significantly reduced NRS pain scores compared to placebo at multiple time points, including 30 min, 1 h, 3 h, 6 h, and 32 h postoperatively, with differences exceeding the minimum clinically important difference of 2 NRS points at the earliest assessments. The MgSO₄ → ketamine (Mg → K) sequence did not differ from placebo at any time point. Cumulative morphine consumption was comparable across groups. No hallucinations or psychomimetic events were observed. Conclusions: Intraoperative ketamine followed by MgSO₄ (K → Mg) provides clinically meaningful postoperative analgesia after open radical nephrectomy; the reversed sequence (Mg → K) offers no benefit over placebo. These findings provide the first clinical confirmation of sequence-dependent NMDA receptor antagonism and support the K → Mg protocol as a safe, simple addition to multimodal perioperative analgesia. Trial registration: ISRCTN registry, ISRCTN83633282. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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23 pages, 1332 KB

Open AccessArticle

4-Week Comparative Outcomes of Standard Physiotherapy, Balneotherapy Plus Physiotherapy and Dextrose Prolotherapy in Patients with Low Back Pain: A Non-Randomized Study

by Stelian Ilie Mociu, Elena Valentina Ionescu, Andreea-Bianca Uzun, Nicolae Ciufu, Alexandra Ecaterina Ciota, Teodora Elena Iliescu, Ioan Calatoiu, Lucian Cristian Petcu and Madalina-Gabriela Iliescu

Medicina 2026, 62(4), 623; https://doi.org/10.3390/medicina62040623 - 25 Mar 2026

Viewed by 541

Abstract

Background and Objectives: Low back pain (LBP) represents a major cause of disability worldwide, with a significant impact on quality of life and functional capacity. Standard physiotherapy is widely used for LBP, whereas comparative short-term evidence on balneotherapy and prolotherapy remains limited. This study aimed to compare clinical outcomes across therapeutic approaches in patients with LBP. Materials and Methods: This non-randomized, three-group interventional cohort study included adult patients diagnosed with LBP lasting more than three months and presenting a baseline Visual Analog Scale (VAS) score ≥ 4. 84 patients were allocated to one of three treatment groups: standard physiotherapy (CG) (25 patients), balneotherapy plus physiotherapy (BG) (28 patients), or prolotherapy (PG) (31 patients). Outcome measures included pain intensity, functional disability, lumbar mobility, quality of life, and psychological status. This clinical study has been officially registered on ClinicalTrials.gov under the identifier NCT07399145. Results: Statistical analyses were performed to assess within- and between-group differences over time. At the 4-week follow-up, all three treatment groups showed significant improvements compared to baseline in pain intensity (VAS; p < 0.001 for PG, BG, and CG) and lumbar mobility (Schober test; p < 0.001 for PG, BG, and CG), and functional disability (RMDQ; p < 0.001 for PG, p = 0.027 for BG, and p = 0.016 for CG). Between-group analyses at T1 revealed significant differences for RMDQ, ODI, Schober, and EQ-5D-5L. In contrast, no significant intergroup differences were observed for VAS, PPT-RS, PPT-LS, total PPT, HADS-A, HADS-D, BDI-II, or PHQ-9. Conclusions: All evaluated interventions improved clinical, functional, and psychological outcomes in patients with LBP. Prolotherapy showed a pattern of more consistent improvements, particularly in disability, spinal mobility, and health-related quality of life. These findings should be interpreted cautiously, given the non-randomized design and baseline differences between groups. Further randomized studies with larger samples and longer follow-up are warranted to confirm these results. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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14 pages, 3172 KB

Open AccessArticle

Lumbar Interlaminar Ventral Epidural Injection Without Catheter at L5–S1 for Lumbosacral Radicular Pain: A Pilot Feasibility Study

by Jiho Park, Seounghun Lee, Sunyeul Lee, ChaeSeong Lim and Yeojung Kim

Medicina 2025, 61(11), 2069; https://doi.org/10.3390/medicina61112069 - 20 Nov 2025

Viewed by 944

Abstract

Background and Objectives: Lumbar interlaminar ventral epidural injection (LIVEI) offers a promising alternative to transforaminal epidural injection (TFEI) by enabling ventral epidural delivery while minimizing complication risks. While previous approaches often required catheter assistance, this pilot study evaluates the safety, technical feasibility, and early outcomes of a simplified LIVEI method at L5–S1 without catheter insertion. Materials and Methods: Twelve patients with lumbosacral radicular pain received unilateral catheter-free LIVEI at L5–S1 between October 2021 and September 2022. This small retrospective pilot cohort did not include a control group. Contrast spread patterns were evaluated fluoroscopically based on AP and lateral views. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Visual Analog Scale (VAS) scores were assessed before and two weeks after the procedure. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Results: Fluoroscopic images confirmed ventral epidural spread in all patients, with 75% showing foraminal extension and 67% demonstrating cranio-caudal spread over two or more levels. Baseline VAS scores averaged 6.5 ± 1.0, decreasing to 3.42 ± 1.31 two weeks post-procedure (p < 0.0001), with a mean reduction of 3.08 ± 1.00. No adverse events or complications were observed. Conclusions: Catheter-free LIVEI at the L5–S1 level demonstrated consistent anterior and multi-level ventral epidural contrast distribution on fluoroscopy, supporting the technical feasibility of this approach. In addition to this radiographic validation, patients achieved clinically meaningful pain relief with excellent tolerability. Further confirmation through larger-scale controlled studies is warranted to validate long-term clinical effectiveness. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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16 pages, 1384 KB

Open AccessArticle

Intravenous Lidocaine for Postoperative Pain and Recovery After Robotic Prostate Adenomectomy: A Retrospective Observational Cohort Study

by Georgiana Maria Popa, Simona-Alina Abu-Awwad, Ahmed Abu-Awwad, Carmen-Ioana Marta, Erika Bimbo-Szuhai, Mihaela Gabriela Bontea, Adrian Gheorghe Osiceanu, Anca Mihaela Bina, Cristian Mihai Moisa Cezar, Ciprian Dumitru Puscas and Mihai O. Botea

Medicina 2025, 61(11), 2045; https://doi.org/10.3390/medicina61112045 - 16 Nov 2025

Cited by 2 | Viewed by 1463

Abstract

Background and Objectives: Effective perioperative pain management remains a key goal of enhanced recovery protocols, especially in minimally invasive urologic surgery, where optimizing comfort while limiting opioid exposure is essential. Intravenous lidocaine has gained attention for its multimodal analgesic and anti-inflammatory properties, yet evidence in robotic prostatectomy remains limited. This study evaluated whether intraoperative lidocaine infusion was associated with lower early postoperative pain scores and reduced opioid use in patients undergoing robotic-assisted radical prostatectomy. Materials and Methods: A retrospective, single-center analysis was conducted at Pelican Clinical Hospital, Oradea, Romania, including 112 patients operated on between January 2020 and December 2023. All procedures were performed by the same surgical and anesthetic teams using standardized ERAS-based protocols. Patients were divided into two groups: the Lidocaine Group (LG, n = 51), who received a bolus of 1.5 mg/kg lidocaine followed by an infusion of 1.5 mg/kg/h during surgery, and the Control Group (CG, n = 61), who received standard anesthesia without lidocaine. Postoperative pain was measured using the visual analog scale (VAS) at 0, 4, 12, and 24 h, and opioid use was converted into morphine milligram equivalents (MME). Secondary outcomes included time to ambulation, gastrointestinal recovery, oral intake, hospital stay, and complications. Results: Pain intensity was significantly lower in the lidocaine group at 4 h postoperatively (VAS 3.5 ± 1.1 vs. 4.3 ± 1.3; p = 0.01), with similar scores later. Total opioid use was reduced by about 18% in the lidocaine group (25.7 ± 9.4 vs. 31.2 ± 10.5 MME; p = 0.03). Recovery parameters and complication rates were comparable between groups, and no lidocaine-related adverse events were recorded. Conclusions: Intraoperative intravenous lidocaine was associated with lower early postoperative pain scores and reduced opioid requirements after robotic-assisted radical prostatectomy without affecting recovery or safety. Its favorable profile and low cost support its inclusion as a practical adjunct in multimodal analgesia within ERAS pathways. Full article

(This article belongs to the Special Issue Anesthesiology, Resuscitation, and Pain Management)

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