Spinal Group Research Articles

Locoregional anesthesia in patients with Brugada syndrome. A retrospective database analysis.

The use of local anesthetics (LA) in individuals with Brugada syndrome (BrS) remains a subject of debate due to the lack of large-scale studies confirming their potential risks. This study primarily aimed to evaluate the incidence of new malignant arrhythmias or defibrillation events in patients diagnosed with BrS during the perioperative period, following the administration of local anesthetics, and within 30 days postoperatively. The secondary objective was to analyze the occurrence of adverse effects during hospitalization, as well as 30-day readmission and mortality rates. A retrospective cohort study was performed on patients with BrS who underwent locoregional anesthesia between January 1, 1996, and September 30, 2020. Anesthetic records and electronic medical records were thoroughly reviewed for up to 30 days following each administration of local anesthetics. A total of 47 procedures involving patients with BrS who underwent locoregional anesthesia were analyzed. The patients were categorized into three groups: 27 in the peripheral nerve block (PNB) group, 13 in the epidural anesthesia group, and 9 in the spinal anesthesia group. One patient in the PNB group experienced intraoperative ventricular fibrillation following the administration of ajmaline. No other adverse events were observed. In this retrospective study, our findings do not indicate an increased arrhythmogenic risk or a higher incidence of adverse events associated with the administration of local anesthetics in patients with BrS. However, the available data are insufficient to confirm the safety of local anesthetic use in this population. Enhanced vigilance is recommended when administering local anesthetics to individuals with BrS. Prospective studies are necessary to further evaluate and establish the safety profile of local anesthetics in this patient group.

Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

BackgroundThe effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA)...

Pain Level and Analgesic Requirements in Patients Who Underwent Vaginal Pelvic Floor Surgery following General or Spinal Anesthesia

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries. Design: This was a retrospective cohort study. Participants/Materials, Setting, Methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient’s age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004). Limitations: This is a retrospective study, thus the choice of anesthesia may be biased. Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.

Hypotension after unilateral versus bilateral spinal anaesthesia: A Systematic review with meta-analysis.

Spinal anaesthesia is frequently used in surgical procedures involving the lower abdomen and extremities, however, the occurrence of hypotension remains a common and clinically important adverse effect. Unilateral spinal anaesthesia seems to be a promising approach to minimise this complication but the effectiveness of this remains controversial. A meta-analysis was undertaken to evaluate the superiority of unilateral spinal anaesthesia over bilateral spinal anaesthesia with regard to the incidence of hypotension and other complications. Systematic reviews and meta-analysis of randomised controlled trials (RCTs). PUBMED, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched from their inception to 5 March 2024. Randomised controlled trials (RCTs) comparing unilateral spinal anaesthesia with bilateral spinal anaesthesia were eligible for inclusion. Observational studies, case reports, case series, and studies not conducted in humans were excluded. The incidence of hypotension, vasopressor requirement, and other complications were compared. Heterogeneity was assessed by subgroup analyses and sensitivity analysis. Twenty-one trials involving 1358 patients undergoing unilateral lower extremity surgery or lower abdominal surgery were included in the meta-analysis. Hyperbaric solutions were used in most trials. The Mantel-Haenszel random-effect model was used for the analysis of binary endpoints, reported as relative risk (RR) with a 95% confidence interval (CI). The incidence of hypotension was significantly lower in the unilateral spinal anaesthesia group compared with the bilateral spinal anaesthesia (RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I2 = 38%). Subgroup analysis shows that the occurrence of hypotension was significantly lower in the unilateral subgroup, regardless of dosage, surgical site, adjuvants to the local anaesthetics, and different definitions of hypotension. Unilateral spinal anaesthesia is associated with a significant reduction in the occurrence of hypotension, despite variations in the definition of hypotension, adjuvants, and site of surgery. These results favour the use of lateral spinal anaesthesia in patients undergoing unilateral lower abdominal or lower limb surgery. However, the GRADE assessment of the quality of evidence was 'low' due to the high risk of bias and heterogeneity. All the results should be treated with caution.

Volume status evaluation by IVC diameter and pleth variability index in spinal anesthesia.

We aimed to predict the risk of hypotension due to spinal anesthesia (HSA) by measuring the diameter and area of the inferior vena cava (IVC-D, IVC-A) through ultrasound and pleth variability index (PVI) in patients who underwent endovenous radiofrequency ablation under spinal anesthesia (SA). This cross-sectional, observational, and prospective study was completed with 64 patients. Before SA, PVI IVC-D, and IVC-A were measured. Patients were divided into two groups as hypotension group (Group 1) and patients who did not developed hypotension after SA (Group 2). Shapiro-Wilk normality test and student's t-test were used for statistical analysis. The mean PVI of Group 1 was higher than Group 2, whereas the mean IVC-D and IVC-A in Group 2 was significantly higher than Group 1 (p = 0.000, p = 0.000, p = 0.001). Cutoff values for hypotension PVI > 15% and IVC-A ≤ 2.98 mm2 (p = 0.001, p < 0.05). PVI and IVC-D and IVC-A measurements are effective and reliable methods that should be used to predict the risk of developing HSA in patients who will undergo surgery under SA.

Comparative Effects of Spinal Anesthesia and Combined Spinal with Peripheral Nerve Blocks on Postoperative Outcomes in Anterior Cruciate Ligament Repair.

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.

Perioperative Pain Observation of Hip Fracture Surgery Patients with Cheek Acupuncture.

The objective of this study is to investigate the impact of cheek acupuncture on perioperative pain in patients with hip fracture. A random number table was utilized to allocate the patients into three distinct cohorts: Only spinal anesthesia was performed (group S), cheek acupuncture was performed before spinal anesthesia (group C), and ultrasound-guided fascia iliaca block was performed before spinal anesthesia (group F). The primary outcome measure was the Visual Analogue Scale (VAS) score within 24hours post-surgery, as well as the level of beta-endorphin. The secondary outcome measures included intraoperative mean arterial pressure (MAP), heart rate (HR), length of hospital stay, postoperative complications, levels of interleukin-6 (IL-6), and degree of motor block. Compared to Group S, patients in group C and group F exhibited significantly lower Visual Analog Scale (VAS) scores at the following endpoints: when the patient is positioned in the spinal anesthesia position (T2); 12hours post-surgery (T5); and 24hours post-surgery (T6). And patients in group C and group F demonstrated a decreased beta-endorphin level at the T6. Compared to Group S, patients in group C and group F displayed reduced Mean Arterial Pressure (MAP) levels at T2. The application of cheek acupuncture therapy in hip fracture surgery can effectively reduce the Visual Analog Scale (VAS) score, enhance perioperative safety, facilitate postoperative recovery, and optimize the overall medical experience for patients. ChiCTR2100043194.

Altieri modified Nesbit corporoplasty for the treatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes.

To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia. A total of 40 patients with congenital penile curvature (CPC) and Peyronie's disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (< 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed. The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria. Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia.

Awake lumbar spine surgery performed under spinal versus conventional anesthesia.

Lumbar spine surgery for discectomy or laminectomy is mostly performed under general anesthesia (GA). Here, we explored whether, in a series of 84 patients, better peri-operative outcomes and lower complication rates could be achieved for those undergoing diskectomy/laminectomy under spinal anesthesia (SA) versus GA. From 2022 to 2023, 84 patients were randomly assigned to undergo lumbar discectomy/laminectomy for stenosis under SA: 42 patients versus GAGA: 42 patients. For these two populations, we analyzed and compared multiple variables, including duration of anesthesia, estimated blood loss (EBL), and outcomes (i.e., including pre/post-operative Visual Analogue Scale, Oswestry disability index, and short-form 36 questionnaires). Major advantages of SA versus GA included a reduced mean EBL, shorter mean operative time, reduced mean hospital length of stay, and fewer post-operative side effects. Notably, baseline heart rate or mean arterial blood pressure showed no significant differences between SA and GA groups. Based on this small preliminary sample of patients undergoing lumbar disc/stenosis surgery, it appeared that SA reduced the mean EBL, offered shorter mean operative times, mean hospital lengths of stay, and fewer post-operative side effects versus GA.

Comparison of intrathecal fentanyl as an adjunct in spinal anaesthesia to ultrasound-guided quadratus lumborum block as an effective postoperative analgesia for Caesarean section surgery.

Postoperative pain in patients, if dealt with inadequately, has been a significant cause of morbidity. The present study compared the postoperative analgesic efficacy of intrathecal fentanyl and ultrasound-guided quadratus lumborum block following Caesarean surgery. A prospective randomised controlled study was planned for parturients who underwent Caesarean surgery under spinal anaesthesia. Patients received bupivacaine (10mg) and 25µg of intrathecal fentanyl in the spinal anaesthesia (group intrathecal fentanyl, n = 30) or 20mL of 0.375% ropivacaine bilateral quadratus lumborum block (group quadratus lumborum; n = 30) after surgery. The visual analogue scale score, quality of recovery-15 score and incidence of ill effects were recorded. The postoperative haemodynamic parameters were comparable between the two groups. The visual analogue scale score at different time intervals decreased after the quadratus lumborum block (p < 0.05). The mean global quality of recovery score was better in the quadratus lumborum group (p < 0.001). In the quadratus lumborum group, the mean time to first ambulation was lower than that in the intrathecal fentanyl group (p < 0.05). The requirement for first-rescue analgesia was earlier in the intrathecal fentanyl group (4.67 ± 0.72) than in the quadratus lumborum group (4.92 ± 0.88). Intrathecal fentanyl and quadratus lumborum block had effective postoperative analgesic effects on Caesarean surgery patients. However, the quadratus lumborum block group exhibited better analgesia and early ambulation than the intrathecal fentanyl group, with an improved quality of recovery.

Effect of Anesthesia Type on Pain and Hemodynamic Parameters in Cesarean Section Surgery: Randomized Controlled Trial

Background: General and spinal anesthesia are commonly used for cesarean sections, each with implications for both the mother and the fetus. The choice of anesthesia technique depends on various factors. While spinal anesthesia is often preferred for cesarean surgeries due to its well-known benefits, general anesthesia may be chosen in emergency situations. The decision is ultimately based on the safety profile and benefits for both the mother and the fetus. Methods: This clinical trial was conducted at Fatemieh Hospital in Hamadan and involved 60 patients undergoing elective cesarean section. The patients were randomly divided into two groups of 30: One group received spinal anesthesia, and the other group received general anesthesia. Variables such as intraoperative bleeding, the Apgar score of the newborn, postoperative pain, and postoperative systolic and diastolic blood pressure were analyzed and compared between the two groups using SPSS software version 16. Results: The mean age of participants in the spinal and general anesthesia groups was 32 ± 3.5 years and 34 ± 3.4 years, respectively. The results showed that the amount of intraoperative bleeding in the general anesthesia group was higher than in the spinal anesthesia group, but this difference was not statistically significant (P = 0.85, P &lt; 0.05). The Apgar scores at the first and fifth minutes in the spinal anesthesia group were higher than those in the general anesthesia group, but this difference was also not statistically significant (P = 0.32, P &lt; 0.05). Postoperative pain in the spinal anesthesia group was significantly lower than in the general anesthesia group (P = 0.001, P &lt; 0.05). Regarding hemodynamic parameters, systolic blood pressure after the operation was higher in the spinal anesthesia group compared to the general anesthesia group (P &lt; 0.05). Conversely, diastolic blood pressure in the general anesthesia group was higher than in the spinal anesthesia group at all measurement stages, though not statistically significant in some measurements (P &gt; 0.05). Conclusions: The results of our study indicate that spinal anesthesia is a preferable and safer method compared to general anesthesia, based on the parameters examined, particularly in emergency cesarean sections.

Description of Hypotension in Cesarean Section Patients Under Spinal Anesthesia Using Conventional and Enhanced Recovery after Surgery Methods

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative management aimed at faster recovery from major surgery, reducing the risk of complications, and shortening the length of stay compared to conventional perioperative methods. Hypotension is a side effect of a cesarean section with spinal anesthesia. This study aims to describe hypotension in patients undergoing cesarean sections with conventional spinal anesthesia methods and the Enhanced Recovery After Surgery (ERAS) method. This study used a quantitative research method with a descriptive design and a cross-sectional approach. The sampling technique was purposive sampling with a total of 40 cesarean section patients, consisting of 20 respondents in the conventional spinal anesthesia group and 20 respondents in the ERAS spinal anesthesia group. Blood pressure measurements were taken before and after spinal anesthesia using a bedside monitor. The data obtained included age and blood pressure, which were analyzed using statistics. The results showed that in the conventional spinal anesthesia group, 15 respondents experienced hypotension (75%), and 5 respondents did not experience hypotension (25%). In the Enhanced Recovery After Surgery (ERAS) spinal anesthesia group, 7 respondents experienced hypotension (35%), and 13 respondents did not experience hypotension (65%).

Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes.

Background and Objectives: The selection of an appropriate anesthesia method is a critical factor in the surgical treatment of proctological diseases, significantly impacting patient outcomes and comfort. Pudendal nerve block (PNB) and spinal anesthesia (SA) are commonly employed in these surgeries, yet the optimal choice between the two remains debated. This study aims to compare the efficacy and safety of PNB and SA in patients undergoing surgical treatment for various proctological conditions, with a focus on postoperative pain management, functional outcomes, and complication rates. Materials and Methods: A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155). Pain levels were assessed using the Visual Analog Scale (VAS), while functional outcomes were measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Statistical analysis was performed to compare the outcomes between the two groups. Results: Patients in the PNB group reported significantly lower postoperative VAS scores compared to those in the SA group, particularly in hemorrhoidectomy and laser hemorrhoidoplasty procedures. The PNB group also demonstrated superior functional outcomes, with lower postoperative WHODAS 2.0 scores and a reduced incidence of urinary retention compared to the SA group. Furthermore, the duration of surgery and hospital stay were significantly shorter for patients in the PNB group. Conclusions: The findings suggest that PNB may offer advantages over SA in proctological surgeries, particularly in terms of pain management, functional recovery, and reduced complication rates. PNB should be considered a viable alternative to SA, particularly in cases where rapid recovery and minimizing complications are priorities. Exceptions to this include specific proctological surgeries, such as those for malignant tumors in the region, complex anal fistulas, proctological conditions arising from inflammatory bowel diseases, and patients on immunosuppressive therapy. Further research is needed to confirm these results and optimize anesthesia selection in this context.

General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience.

Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.

Unilateral Spinal Anesthesia Versus Conventional Spinal Anesthesia in Elderly Patient Undergoing Surgery for Upper Extremity of the Femur

Aim of the study: To compare unilateral spinal anesthesia (USA) and conventional spinal anesthesia (SA) in elderly patient undergoing surgery for upper extremity of the femur fracture. Methodology: It was a prospective descriptive analytical randomized study of 16 months including 42 patients carried out in the departments of anestesiology and orthopedics-traumatology of the National Hospital of Niamey. The patients were randomized in two groups: the first group unilateral spinal anesthesia (USA) received a dose of 7.5mg of Bupivacain with 25ɤ of Fentanyl; the second group conventional spinal anesthesia (SA) received 12.5mg of Bupivacain with 25ɤ of Fentanyl. The choice of the administrated dose of Bupivacain were random and alternated half the time. Results: During the time of our study, we registred 42 patients we divided in two groups of 21. In the intraoperative period, the mean arterial pressure (MAP) and the mean heart rate (HR) were comparative in the two groups of patients. There was no difference in the time to installation of the sensory and motor block (7mn and 9mn in USA group vs 7mn and 8mn in conventional SA, P-value=0.79) and neither in it’s duration (153.1mn and 162.8mn in USA group vs 176.5min and 182.81mn in conventional SA group, P-value=0.1 and 0.14). The dose of ephedrine used intraoperative was 14.40mg in conventional SA group and 19.20mg in USA group, the difference were not statistically significant (P-value=0.36). Fluid replacement was done in the two groups with an average of 1.74L in USA group and 1.62L in conventional SA group, with no statistically significant difference (P-value=0.87). The pain was also comparative in the two groups up to 18hours postoperative. The difference in the intensity of this pain was statistically significant between 18hours and 24hours, it was more important in USA group however releived by analgesics of level 1 (P-value=0.002). Intra and postoperative complications were comparative in the two groups ...

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

The Effect of Anesthesia Type on the Stability of the Surgical View on the Monitor in Retrograde Intrarenal Surgery for Renal Stone: A Prospective Observational Trial.

Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0-10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia.

Anesthesia Type Outcome in Severe Pre-eclampsia with Caesarean Section

Background: Preeclampsia is a hypertensive disorder during pregnancy with fetomaternal mortality. The choice of anesthesia method for cesarean sections among preeclamptic women is still debated. Objective: To compare the outcomes of spinal and general anesthesia in a cesarean section among preeclamptic women. Methods: A prospective study was conducted at Al-Imam Al-Sajjad Hospital/Al-Najaf Health Directorate from February 2021 to September 2023. Women undergoing cesarean sections due to severe preeclampsia were enrolled in the spinal or general anesthesia group. Data on maternal age, gestational age at delivery, parity, Apgar scores, maternal mortality and perinatal mortality were recorded. The background characteristics and outcomes were compared between both groups. We excluded women with mild preeclampsia, multiple pregnancies, other pregnancy medical disorders, gestational age &lt; 32 weeks, cases of eclampsia, and general anesthesia following spinal anesthesia failure. Results: The general anesthesia group had a significantly lower Apgar score at 1 minute than the spinal anesthesia group (27.3% and 57.4%, p=0.006), and at 5 minutes (15.2% and 37.03%, p=0.005). The study groups showed no significant difference regarding maternal and perinatal mortality. Conclusions: Maternal and perinatal mortality were not affected by anesthesia type in severe preeclampsia, but general anesthesia caused a higher proportion of birth asphyxia.

Relationship Between Optional General and Regional Anesthesia Applied to Patients Undergoing Cesarean Section and Sleep Quality

Objective: This study aimed to explore the association between anesthesia type (spinal or general) administered during cesarean section and subsequent sleep quality in women. Methods: This study conducted from April to August 2023, it involved 150 pregnant participants evenly split between spinal and general anesthesia groups. Patient categorization was based on the type of anesthesia received. Data collection utilized a combination of a Demographic Information and Postpartum Period Survey form, along with the Postpartum Sleep Quality Scale (PSQS). Demographic and clinical details were gathered and compared between the two anesthesia groups. Results: Indicated a higher level of education among the spinal anesthesia group (p &amp;lt; .01). Significant differences were also observed between the groups concerning economic status and number of deliveries (p &amp;lt; .01 and p = .01, respectively). Interestingly, patients who underwent general anesthesia exhibited a notably higher total sleep score, demonstrating a statistically significant difference (p &amp;lt; .01). Weak but statistically significant positive correlations were found between age and number of deliveries, while a weak negative correlation was noted for economic status. Conclusion: Our results indicated that age and general anesthesia were the independent risk factors affecting postpartum sleep quality. Given the increasing trend of women giving birth at alate age, health professionals, particularly midwives, need to be aware of the increased risk of poor sleep quality and should provide suitable advice.