Search Results (12)

Background: Intrathecal morphine (ITM) is a widely used reference approach for post-caesarean analgesia but is associated with neuraxial opioid-related side effects, particularly pruritus and nausea. The transversalis fascia plane (TFP) block is a relatively recent regional technique targeting the transversalis fascia; however, comparative effectiveness data in the obstetric setting remain limited. This study aimed to evaluate whether TFP block provides analgesic outcomes broadly similar to those observed with ITM with respect to 24 h rescue analgesic requirement following elective caesarean delivery under spinal anesthesia, and to compare patient-centered recovery quality. Methods: This prospective, single-center, observational comparative cohort study was conducted in a tertiary obstetric unit. Sixty American Society of Anesthesiologists (ASA) physical status II parturients undergoing elective caesarean delivery under spinal anesthesia were included. Postoperative analgesic strategy was determined according to routine clinical practice, with patients receiving either ITM (100 µg) or bilateral ultrasound-guided TFP block with 0.25% bupivacaine. The primary outcome was cumulative tramadol consumption within the first 24 h postoperatively. Secondary outcomes included Numerical Rating Scale (NRS) pain scores at rest and on movement at 0, 3, 6, 12, and 24 h; postoperative nausea and vomiting (PONV) and pruritus scores; and Obstetric Quality of Recovery-11 (ObsQoR-11) scores at 24 and 48 h. A non-inferiority analytical framework was applied to the primary outcome. Results: Both groups had a median tramadol consumption of 0 mg (interquartile range (IQR) 0–0). Rescue analgesic rates were 23.3% (ITM) versus 16.7% (TFP; OR 0.66, 95% CI 0.18–2.36; p = 0.748). Within an exploratory observational non-inferiority analytical framework, the findings were consistent with non-inferiority of TFP block; however, these analyses should be interpreted as hypothesis-generating rather than confirmatory (risk difference −6.7 percentage points; upper 95% CI +13.5% relative to a prespecified margin of +15%). TFP block was associated with higher ObsQoR-11 scores at 24 h (median 96 vs. 88; p = 0.010; Cliff’s δ = −0.39) and 48 h (median 96 vs. 91; p = 0.017; Cliff’s δ = −0.36). Pruritus at 6 and 12 h was nominally lower in the TFP group. Conclusions: In this prospective observational cohort, TFP block was associated with analgesic outcomes broadly similar to those observed with ITM, with exploratory differences in patient-centered recovery measures. Within the applied exploratory observational analytical framework, these findings were broadly consistent with non-inferiority; however, given the observational design, results should be interpreted cautiously, and the present study does not establish formal non-inferiority or equivalence. TFP block may represent a potential opioid-sparing option warranting confirmation in adequately powered randomized studies. Full article

Background/Objectives: Fenestrated and branched endovascular aortic repair (F/BEVAR) is increasingly used for the treatment of complex aortic aneurysms, and is traditionally performed under general anesthesia (GA). Data on the use of local anesthesia (LA) for F/BEVAR remain limited. This study aimed to report early outcomes of F/BEVAR performed under LA versus GA, with a focus on feasibility and perioperative complications in a high-risk patient population. Methods: This single-center retrospective analysis included patients undergoing F/BEVAR under LA or GA. Primary outcomes were in-hospital mortality and in-hospital complications. Secondary outcomes included early reintervention, intensive care unit and hospital length of stay, blood transfusion requirements, and technical success. Results: A total of 359 patients were included, of whom 25 (7.0%) were treated under LA and 334 (93.0%) under GA. Conversion from LA to GA occurred in 6 patients (24%). Patients in the LA group represented a higher-risk cohort, with advanced age, higher ASA class, larger aneurysm diameters, and a greater proportion of emergency and ruptured repairs. Technical success was high, and procedural metrics were within expected ranges. In-hospital mortality was numerically higher in the LA group (12.0% vs. 2.9%, p = 0.05). Overall, in-hospital complications were more frequent in the LA group (68.0% vs. 41.3%, p = 0.009), including a higher rate of spinal cord ischemia (24.0% vs. 8.5%, p = 0.02). Blood transfusion requirements were also greater in patients treated under LA (p = 0.004), while blood loss, ICU stay, and hospital length of stay were comparable. Early reintervention occurred more frequently in the LA group (31.8% vs. 10.4%, p = 0.009). Conclusions: LA appears feasible in selected high-risk patients undergoing complex F/BEVAR. However, given substantial baseline differences between groups, no conclusions can be drawn regarding comparative safety or efficacy relative to GA. These findings should be considered preliminary. Full article

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary. Full article

Background/Objectives: Postoperative opioid exposure after lumbar fusion remains a key clinical concern. Understanding which perioperative factors are associated with lower postoperative opioid use may help optimize recovery after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). This study aimed to determine if patients undergoing MIS-TLIF under spinal anesthesia (SA) showed lower postoperative opioid use compared to those undergoing MIS-TLIF under general anesthesia (GA). Methods: We retrospectively studied all adult patients (>18 years) undergoing 1- and contiguous 2-level MIS-TLIFs performed by a single surgeon. Patients undergoing the procedure under GA were compared to those undergoing the procedure under SA. Postoperative oral opioid use, up to 3 months post discharge, was collected. A 1:1 propensity score matching (PSM) protocol was implemented. Each outcome variable was initially assessed using univariate regression. Predictor variables with a p-value < 0.2 were included in the multivariate regression model. This was a retrospective, non-randomized study, and residual confounding cannot be excluded despite PSM. Results: The matched groups (n = 50 in each group) did not differ significantly depending on demographics or levels fused. Before regression, mean number of postoperative opioid prescriptions (p = 0.03), mean total operating room (OR) time in minutes (p < 0.01), and median length of stay (LOS) in days (p = 0.03) were significantly different. Multivariate regression showed that the GA group received 216.5 more total morphine milligram equivalents than the SA group (95% CI = 0.7–432.2, p = 0.049). The days of opioid use were higher in the GA group by 3.8 days (95% CI = 0.5 to 7.1, p = 0.025). On multivariate regression, LOS in hours was greater in the GA group by 14.1 h (p = 0.042). Conclusions: SA is an effective anesthetic modality for spinal surgery with the advantages of reduced postoperative opioid use, reduced OR time, and shorter LOS compared to GA. Full article

Background and Objectives: The association between different anesthesia modalities and spermiogram parameters and reproductive outcomes in patients undergoing microscopic subinguinal varicocelectomy (MSV) remains unclear. In this retrospective cohort study, we aimed to compare spermiogram parameters and pregnancy rates between patients receiving general anesthesia (GA) versus spinal anesthesia (SA) for MSV with 2-year follow-up data. Materials and Methods: Male patients aged between 18–50 years, with ASA physical scores between I–III, who underwent unilateral or bilateral primary MSV, were included in the study. To minimize selection bias and balance the baseline characteristics between the GA group and SA group, we employed a propensity score matching approach, matching all 38 SA patients with 380 GA patients selected from a larger pool. Patients with complete 24-month follow-up data were included in the final analysis. The primary outcome of our study was determined as evaluating sperm count changes. Secondary outcomes included other sperm parameters (motility, morphology and semen volume), natural pregnancy rates, perioperative complications and recovery parameters. Results: The final analysis included 418 patients who met all inclusion criteria and completed the follow-up period. The study population comprised 380 patients in the GA group and 38 in the SA group. No significant difference was found between the groups in terms of sperm count. Greater improvement in sperm motility was observed in the SA group starting from the third month onwards (p = 0.027). Natural pregnancy was achieved in 16/38 (42.1%) of SA patients versus 125/380 (32.9%) of GA patients (p = 0.031). In addition, better results were obtained in terms of recovery parameters in the SA group. Other results were comparable between the groups. Conclusions: Spinal anesthesia for MSV was associated with greater improvement in sperm motility and higher natural pregnancy rates compared to general anesthesia, despite comparable sperm count improvements. These associations warrant further investigation in prospective randomized trials. Full article

Background/Objectives: Spinal anesthesia (SA) for cesarean section and epidural analgesia (EA) for vaginal delivery induce hemodynamic changes that may compromise maternal and fetal safety. In this observational, hypothesis-generating study, we used impedance cardiography (ICG) to characterize maternal hemodynamic responses to EA for labor versus SA for cesarean delivery and to describe hemodynamic profiles associated with commonly used local anesthetic and vasopressor regimens. Methods: In this observational study, 132 women at term were included (52 with epidural analgesia (EA), 80 with spinal anesthesia (SA)). Hemodynamic parameters were measured using the ICON electrical cardiometry monitor (Osypka Medical GmbH). ICON and oscillometric blood pressure (BP) monitoring captured cardiac index (CI), stroke volume (SV), heart rate (HR), systemic vascular resistance index (SVRI), and thoracic fluid content (TFC) at T0 (baseline), approximately 5 and approximately 10 min, skin incision, delivery, and oxytocin administration. Results: CI remained stable and comparable between EA and SA (3.9 ± 0.6 vs. 3.9 ± 0.6 L/min/m²; p = 0.530). SV was higher in EA (85.1 ± 11.3 vs. 78.1 ± 9.7 mL; p < 0.001), whereas HR was higher in SA (92.2 ± 12.9 vs. 85.8 ± 12.5 bpm; p = 0.009). In EA, ropivacaine and bupivacaine showed similar hemodynamic profiles. Within the SA cohort, women managed with phenylephrine infusion had lower CI and HR but higher MAP and SVRI compared with those receiving ephedrine boluses, consistent with the expected pharmacodynamic profiles of these agents. Conclusions: ICG was feasible and provided dynamic, noninvasive estimates of maternal cardiovascular adaptation during obstetric anesthesia. In this non-randomized, exploratory cohort, descriptive differences in hemodynamic profiles between vasopressor strategies were more pronounced than between local anesthetics. Phenylephrine-based management showed a pattern of higher BP and SVRI but lower CI and HR, whereas ephedrine-based management tended to preserve CI through chronotropic effects. Full article

Orthopedic and lower limb fracture surgeries are among the most frequent emergency procedures and are commonly performed under general anesthesia (GA). Background and clinical significance: Epidemiologically, postoperative coma after GA is rare (0.005–0.08%), but delayed awakening (2–4%) and postoperative delirium or postoperative cognitive dysfunction (POCD) (15–40%) remain significant. These neurological complications increase markedly in vulnerable brain patients with psychiatric, cerebrovascular, or neurodegenerative disorders. Methods: This mechanistic narrative review synthesizes evidence from clinical and experimental studies (1990–2025) comparing the effects of general versus Regional (RA)/local (LA) or spinal anesthesia in vulnerable neuropsychiatric populations “with pre-existing brain illness” undergoing orthopedic surgery. Domains analyzed include neuropsychiatric medications effects and interactions with the GA process and with general anesthetic agents, alongside alterations in neurotransmitter modulation, cerebrovascular autoregulation, mitochondrial dysfunction, oxidative stress, redox imbalance, and neuroinflammatory activation. The review summarizes evidence on how the choice of anesthesia type influences postoperative brain outcomes in patients with known neurological conditions. Results: From previous studies, patients with psychiatric and/or chronic brain illness have a 3–5-fold increased risk of delayed emergence and up to 60% incidence of postoperative delirium. Pathophysiological mechanisms involve GABAergic overinhibition, impaired perfusion, mitochondrial energy failure, and inflammatory amplification. Regional/local and spinal anesthesia may offer physiological advantages, preserve cerebral perfusion, and lower neurological complication rates. Conclusions: General anesthesia may exacerbate pre-existing brain vulnerability, converting reversible neural suppression into irreversible dysfunction. Therefore, whenever possible, regional/local or spinal anesthesia with or without sedation should be prioritized in those neurologically vulnerable patients to reduce the length of hospital stay (LOS) and to lower postoperative neurological complications and risks in psychiatric and neurologically unstable patients. Full article

Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic outcomes of GA versus SA in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective review of 18 TLIF patients (2018–2022) was performed, with 9 patients in each cohort. Patients were matched by demographics and procedure type. Data collected included operative time, blood loss, complications, postoperative opioid utilization, and 30-day readmissions. Costs were analyzed in categories: anesthesia, implants, inpatient care, operating room (OR) supplies, OR time, and PACU fees, using Wilcoxon Rank T-tests and Pearson Chi-Squared tests. Results: Clinical outcomes such as blood loss, and operative time were similar between groups. However, SA patients had significantly shorter LOS compared to GA (SA: 12 h vs. GA: 84 h, % difference: −150%, p = 0.04). Additionally, SA patients had lower total direct costs ($27,881.85 vs. $35,669.01; p = 0.027). Significant cost reductions with SA were noted in OR supplies/medications ($7367.93 vs. $10,879.46; p = 0.039) and inpatient costs ($621.65 vs. $3092.66; p = 0.027). Within these categories, reductions were observed for intravenous solutions, sedatives/anesthetics, pressure management, labs, imaging, evaluations, hospital care, and medications. Although costs for implants, anesthesia care, OR time, and PACU fees were lower with SA, these differences did not reach statistical significance. Conclusions: In TLIF for DLSD, SA provides significant economic advantages over GA while yielding comparable clinical outcomes. These results support SA as a cost-effective alternative, warranting further prospective studies to confirm these findings. Full article

Objectives: This study aimed to compare the effectiveness of spinal anesthesia (SA) alone versus combined spinal anesthesia with adductor canal block (ACB) and sciatic nerve block (SNB) (SA + ACB + SNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. We hypothesized that SA + ACB + SNB would provide better analgesia, greater patient satisfaction, and shorter postanesthesia recovery times than SA alone. Methods: A prospective randomized controlled trial was conducted with 60 patients aged 15–49 years scheduled for elective arthroscopic ACL reconstruction. Participants were randomly assigned to receive either SA or SA + ACB + SNB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 12, and 24 h post-operation. General health was evaluated using the 12-item Short Form Survey (SF-12) at 1 month postoperatively. Range of motion and analgesic consumption were also recorded. Results: The median VAS score at 4 h post-operation was significantly lower in the SA + ACB + SNB group compared to the SA group (0 [IQR: 0–1] vs. 2 [IQR: 1–3], p = 0.0137). No significant differences in VAS scores were found at 12 h (p = 0.9282) and 24 h (p = 0.5809). PCS-12 and MCS-12 scores did not differ significantly between groups. The SA group had a lower postoperative range of motion (ROM) compared to the SA + ACB + SNB group, with a mean active ROM of 40.67 degrees (±23.52) versus 72.17 degrees (±24.69), respectively (p < 0.0001). Analgesic consumption was similar, with 53.33% of participants in each group using postoperative analgesics (p = 1.0). The mean surgery duration was 74.6 min. The gender distribution was 83% male and 17% female, with an average age of 27.7 years. Conclusions: Adding ACB and SNB to spinal anesthesia improved immediate postoperative pain relief and preserved range of motion in patients undergoing ACL reconstruction, suggesting potential clinical benefits in pain management and functional recovery. Full article

A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients’ general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation. Full article

Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis (OA) of the knee, because it alleviates pain and restores function of the knee. However, TKA-associated hemorrhage and subsequent anemia remain a concern. Most previous studies have defined meaningful postoperative bleeding as blood loss > 500 mL or hemoglobin (Hb) drop > 20 g/L. Therefore, we defined significant hemorrhage as a postoperative Hb drop more than 20 g/L in this study, and we investigated possible risk factors related to significant hemorrhage in TKA and whether these risk factors are modifiable. This retrospective study was conducted through a comprehensive review of the perioperative records of patients with OA of the knee who underwent TKA between January 2009 and December 2015 at our hospital. Patients were allocated into two groups: patients in Group A had their Hb drop ≤ 20 g/L; patients in Group B had their Hb drop > 20 g/L. Factors analyzed included sex, age, body mass index (BMI), the American Society of Anesthesiologists (ASA) classification, comorbidities, preoperative platelet count, use of tranexamic acid (TXA), operation time, and type of anesthesia. A total of 3350 patients met the criteria for analysis, with 1782 patients allocated to Group A and 1568 patients to Group B. Five independent risk factors for significant hemorrhage were identified: male sex (odds ratio(OR), 1.29; 95% confidence interval(CI), 1.08–1.53; p = 0.005), age (OR, 1.02; 95% CI, 1.01–1.03; p = 0.001), use of TXA (OR, 0.39; 95% CI, 0.34–0.45; p < 0.001), spinal anesthesia versus general anesthesia (OR, 0.71; 95% CI, 0.56–0.90; p = 0.004), and preoperative platelet count (OR, 0.96; 95% CI, 0.93–0.98; p = 0.001). Of these identified risk factors, preoperative platelet count, use of TXA, and spinal anesthesia are modifiable. These potentially modifiable risk factors need to be taken into consideration when making both the perioperative care and anesthesia plan by surgeons and anesthesiologists, especially in patients at risk of significant hemorrhage. Full article

Background: Cesarean deliveries represent a large percentage of deliveries worldwide. Patients undergoing repeat cesarean deliveries are known to have increased risks for surgical complications. However, little is known regarding potential differences in pain. We sought to compare postoperative opioid consumption and pain scores in opioid naïve patients undergoing primary versus repeat non-emergent cesarean delivery. Methods: This was a retrospective cohort study. Patient inclusion criteria included: having a non-emergent cesarean delivery, receiving a spinal procedure for surgical anesthesia without general anesthesia, and following the same postoperative pain management protocols. Exclusion criteria included: history of opioid tolerance, illicit drug use, or prior, non-obstetric, major abdominal surgery. The primary outcome marker was total morphine equivalents consumed 0–72 h post-procedure compared between the primary versus repeat cesarean delivery groups. Secondary outcome markers were opioid consumption and pain scores in 24-h period increments for the first 72 h postoperatively. Results: 1617 patients were screened. 217 primary and 377 repeat cesarean deliveries met criteria for comparison. Reduced opioid consumption was demonstrated for the total opioid consumption 0–72 h for the repeat cesarean delivery group (median = 35) compared to the primary cesarean delivery group (median = 58), p = 0.0005. When divided into 24-h periods, differences were demonstrated for the 24–48 and 48–72 h periods but not the 0–24 h period. Pain scores did not differ statistically. Conclusion: Opioid naïve obstetric patients who undergo non-emergent repeat cesarean delivery demonstrate lower opioid consumption in the postoperative period. Providers should be aware of this potential difference in order to better educate patients and provide adequate pain management. Highlights: The study reviewed differences in opioid consumption between primary and repeat cesarean deliveries. All patients received the same protocol for spinal dosage and pain management. Repeat cesarean deliveries were associated with lower opioid consumption. Full article