To evaluate the effectiveness and safety of external cephalic version (ECV) performed with tocolysis and sedation or spinal anesthesia, and to identify predictors of ECV success, complications, and delivery outcomes after successful ECV. This 10-year cohort study included 990 pregnant women with term non-cephalic presentation at a tertiary hospital in Spain. Data were collected retrospectively (2014-2020) and prospectively (2020-2024). All ECVs followed a standardized protocol using ritodrine plus either propofol sedation or spinal anesthesia. Multivariable logistic regression identified predictors of ECV success and complications, and delivery outcomes were recorded. ECV was successful in 691/990 (69.8%). Factors associated with higher success included a deepest amniotic fluid pocket >30 mm (OR = 1.80; 95%CI 1.04-3.11) and transverse lie (OR = 3.60; 95%CI 1.74-7.45). Lower success was observed in nulliparous women (OR = 0.55; 95%CI 0.40-0.76) and those with BMI between 30 and 35, and >35 kg/m2 (OR = 0.53 and 0.49 respectively). Complications occurred in 101/990 (10.2%), including 67/990 (6.7%) emergent cesarean sections. After successful ECV, 556/691 (80.5%) delivered vaginally. In this high-volume tertiary center, ECV performed with systematic tocolysis and sedation or spinal anesthesia achieved high success and low complication rates, supporting the safety and feasibility of this optimized protocol.

Introduction: Spinal anaesthesia is preferred for infraumbilical surgeries due to its rapid onset and effective postoperative analgesia. Ropivacaine, a long-acting local anaesthetic with reduced cardiotoxicity, is increasingly used with adjuvants to enhance block characteristics. Intrathecal adjuvants like fentanyl are being increasingly used to improve or prolong the anaesthetic and analgesic effects. Aim: To compare the effects of 0.75% hyperbaric ropivacaine alone versus 0.75% hyperbaric ropivacaine with fentanyl (25 μg) as an adjuvant in spinal anaesthesia for infraumbilical surgeries. Materials and Methods: This randomised controlled study was conducted at tertiary care facility at the Operation Theatre (OT) complex in the Department of Anaesthesiology at Dhiraj Hospital, Smt. Bhikhibhen Kanjibhai Shah Medical Institute and Research Centre Vadodara, Gujarat, India from January 2023 to June 2024. Eighty patients undergoing elective infraumbilical surgeries were divided into two equal groups of 40 patients each. Group R (Ropivacaine only) received intrathecal 0.75% hyperbaric ropivacaine 2.5 mL+normal saline 0.5 mL, while group RF (Ropivacaine+Fentanyl) received intrathecal 0.75% hyperbaric ropivacaine 2.5 mL+fentanyl 25 μg. The parameters studied were onset and duration of sensory and motor blockade, haemodynamic changes, sedation scores, two-segment regression time, duration of analgesia, and sideeffects. Statistical analysis was performed using Student’s t-test and Chi-square test with p-value <0.05 considered significant. Results: The mean age in group R was 64.5±7.2 years and group RF was 67.8±6.9 years. The time to S2 regression was significantly longer in group RF (118.8±12.8 min) compared to group R (104.5±11.2 min) (p-value <0.001). group RF achieved higher sensory block level (T8 vs T10, p-value <0.001) with shorter motor block duration (208±59 vs 282±56 minutes, p-value <0.001). VAS scores were lower in group RF (3.0±1.5 vs 4.5±1.8, p-value=0.01). Time to rescue analgesia was significantly prolonged in group RF (320±55 vs 210±45 minutes, p-value <0.001). Sedation was higher in group RF (7.5% vs 0%, p-value=0.04) with no significant haemodynamic differences. Conclusion: Addition of intrathecal fentanyl 25 μg as an adjunct to 0.75% hyperbaric ropivacaine provides superior analgesia, shorter motor blockade, and prolonged postoperative pain relief while maintaining haemodynamic stability in comparison to intrathecal 0.75% hyperbaric ropivacaine alone.

Fetal heart rate abnormalities after spinal analgesia or combined spinal-epidural analgesia are well described. Multiple mechanisms were involved like imbalance of epinephrine or the occurrence of hypotension. Few studies have studied the impact of labor epidural analgesia. Our aim was to evaluate risk factors for abnormal fetal heart rates occurring within one hour of labor epidural analgesia. This was a monocentric retrospective cohort study. Women undergoing labor epidural analgesia for a singleton cephalic pregnancy with at least 37 weeks of amenorrhea and attempted vaginal delivery were included. Fetal heart rates in the hour before and after labor epidural analgesia was analyzed. Two groups were compared according to the occurrence of abnormal fetal heart rate. We included 320 women. The rate of abnormal fetal heart rate after labor epidural analgesia was 22.8% (73/320). After multivariate analysis, the risk factors associated with the occurrence of abnormal fetal heart rate were uterine hypertonia (odds ratio [OR] = 18.3; 95% confidence interval [CI] [4.3-77.3]; p <0.0001), severe arterial hypotension (OR = 5.8; 95% CI [2.3-14. 8]; p <0.001), presence of abnormal fetal heart rate before labor epidural analgesia (OR = 4.3; 95% CI [1.8-9.9]; p =0.0007), small for gestational age (OR = 3.4; 95% CI [1.0-11.4]; p =0.04), vaginal delivery within one hour of labor epidural analgesia (OR = 3.2; 95% CI [1.2-8.4]; p =0.02). Factors known beforehand (small for gestational age, abnormal fetal heart rate) or occurring afterwards (uterine hypertonia, severe hypotension) should be suspected or anticipated.

Compared to standard labor epidurals, placement of a dural puncture epidural (DPE) has been shown to improve labor analgesia efficacy, speed onset of analgesia, and decrease failure rates. However, there is a concern of increased post-dural puncture headache (PDPH) risk. A 25-gauge or larger spinal needle is typically needed for a DPE to have improved efficacy over a standard epidural. A prior meta-analysis comparing combined spinal-epidurals (CSEs) with epidurals did not identify a difference in PDPH rates, but many of the included randomized controlled trials (RCTs) used smaller diameter (27-29 gauge) spinal needles. This systematic review and meta-analysis of RCTs evaluates headache frequency following CSE or DPE labor analgesia techniques with 24- or 25-gauge spinal needles. Medline, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Web of Science Core Collection, and Cochrane databases were searched on May 7, 2024, for RCTs comparing either DPE or CSE techniques using 24- or 25-gauge spinal needles with epidural labor analgesia. The primary outcome was headache. The risk-of-bias 2 tool was used to assess bias. The odds ratio (OR) was the chosen effect size using binomial family Bayesian estimation. The reference category for estimation was the conventional epidural technique group. Encompassing 3278 patients, 1765 (53.8%) received labor epidurals, 971 (29.6%) received DPEs, and 542 (16.5%) received CSEs. The rate of headaches in both groups was low, with headache rates of CSE/DPE and epidural groups (0.59% vs 0.34%), respectively. Headache was a secondary outcome in all the RCTs. In 10 of the 16 RCTs (62.5%), no patients of 1428 (0%; 95% credible interval [CI], 0.00-0.25) reported a headache. A total of nine (0.6%) headaches were reported in the DPE/CSE patients (denominator 1513) and six (0.3%) headaches were reported in the traditional epidural patients (denominator 1765). The posterior distribution of the treatment effect (θ) showed that the log OR of 0.35 favored the control group as having fewer events, but the number of events was rare, and the 95% CI was wide (-0.49 to 1.22). Headache was a rare event in both groups. Although these results are reassuring that either technique is clinically safe, they should be interpreted cautiously. A large RCT examining PDPH as the primary outcome with long-term follow-up is needed to more precisely determine if placement of a DPE or CSE with a 24- or 25-gauge spinal needle increases the risk of PDPH.

Incidence of spinal-epidural haematoma after neuraxial anaesthesia for total hip and knee arthroplasty: a single-centre analysis of 96 103 consecutive cases from 2013 to 2023.

Postoperative pain after total hip arthroplasty (THA) remains a major barrier to early mobilization and recovery in older adults. Enhanced recovery pathways increasingly emphasize potentially motor-sparing regional anesthesia to ensure effective analgesia while preserving lower-limb strength and reducing opioid use. This prospective, randomized, controlled trial with blinded outcome assessment compares two potentially motor-sparing regional analgesic strategies in elderly patients undergoing elective THA under spinal anesthesia. Patients receive either a pericapsular nerve group block combined with a lateral femoral cutaneous nerve block or a combined lumbar and sacral erector spinae plane block, with spinal anesthesia alone as the control. The primary outcome is cumulative opioid consumption during the first 48 postoperative hours, expressed as morphine milligram equivalents. Secondary outcomes include postoperative pain intensity, quadriceps strength, time to first ambulation, and adverse events. The protocol is based on recent randomized trials, systematic reviews, and anatomical studies of potentially motor-sparing techniques for hip surgery. The trial is registered at ClinicalTrials.gov (NCT07180979). This trial aims to compare the clinical profiles of targeted capsular versus segmental fascial plane approaches for postoperative analgesia in THA and to support evidence-based optimization of potentially motor-sparing regional anesthesia in elderly patients. The www.clinicaltrials.gov identifier is NCT07180979.

Visceral traction response (VTR) occurs in over 40% of cesarean delivery under spinal anesthesia. This study evaluated the efficacy and safety of intraoperative remimazolam combined with nalbuphine for attenuating VTR. In this prospective, randomised, double-blind, placebo-controlled trial, 72 parturients undergoing elective cesarean delivery under spinal anesthesia received either remimazolam (0.05mg/kg) with nalbuphine (0.1mg/kg) (R + N group, n = 36) or normal saline (Placebo group, n = 36) after umbilical cord clamping. The primary outcome was positive traction response incidence. The R + N group demonstrated significantly lower positive traction response incidence (5.6% vs. 41.7%, p < 0.001) and reduced VTR scores during abdominal exploration and suturing. The incidence of nausea (22.2% vs 58.3%, p = 0.002) and chest tightness (8.3% vs 36.1%, p = 0.005) was significantly lower in the R + N group. Maternal satisfaction was higher (9.56 ± 0.88 vs. 7.11 ± 1.47, p < 0.001). No significant hemodynamic differences or serious adverse events occurred. Remimazolam combined with nalbuphine significantly reduces VTR during cesarean delivery, providing effective sedation and analgesia while maintaining hemodynamic stability, representing a safe adjunct to neuraxial anesthesia. Chinese Clinical Trial Registry ChiCTR2500108913, registered 9 September 2025.

There is a paucity of uterine oxytocin receptors during preterm gestation. Whether this affects the requirement of oxytocin dose for uterine contraction in patients with preterm gestation is not researched. We compared effective dose in 90% of target population (ED90) of oxytocin infusion for satisfactory uterine tone during cesarean delivery in patients with preterm and term pregnancy. This biased coin sequential allocation, dose finding study, with triple blinding to dose allocation included nonlaboring women >18 years posted for cesarean delivery under spinal block, into either term or preterm group (n = 30 each; completed or <37-week gestation, respectively). Oxytocin infusion was initiated at 13 IU·h-1 in the first patient in both groups. Dose in subsequent cases was determined by response to oxytocin in previous patient of a particular group (dosing interval = 2 IU·h-1). Uterine tone was assessed using the one-finger palpation method by the surgeon. Myometrial oxytocin receptor expression was also evaluated on tissue obtained during surgery, using immunohistochemistry (IHC). The ED90 of oxytocin infusion to prevent intraoperative uterine atony was 1.5 times greater in the preterm group (25.7 IU·h-1 [95% confidence interval {CI}, 16.4-35.1]) as compared to the term group (16.2 IU·h-1 [95% CI, 14.8-17.7]). Intraoperative oxytocin amount was significantly greater (14.3 [11.7-17.5] vs 12.8 [10.4-14.7] IU; P = .048), and the need of additional uterotonic was clinically higher (16% vs 10%; effect size = 0.5 [95% CI, 0.1-2.5]; P = .448) for the preterm group. IHC showed increased oxytocin receptor expression for term versus preterm group (P = .040). Incidence of oxytocin-associated hypotension was greater for preterm group (50% vs 13%; P = .002). During cesarean delivery, oxytocin requirement is almost 1.5 times greater for preterm as compared to term pregnancy. This was supported by decreased expression of the myometrial oxytocin receptor upon IHC.

The recent escalation of conflict in Gaza has resulted in a substantial burden of trauma-related injuries, particularly orthopedic trauma, with a total of 362 patients included in this study. This study presents a retrospective descriptive analysis of epidemiology, injury patterns, and clinical management of encountered orthopedic trauma cases during the conflict. This study aimed to characterize the mechanisms, patterns, and outcomes of orthopedic injuries sustained during the ongoing war in Gaza, with the goal of informing surgical response, resource allocation, and emergency preparedness in conflict settings. Data were retrospectively collected from the paper medical records of 362 patients with both direct conflict-related trauma and indirect conflict-affected orthopedic conditions, treated at the Jordanian Military Field Hospital – Southern Gaza (Khan Younis), between June 22 and October 2, 2024. Variables included demographic data, injury mechanisms, anatomical and injury types, surgical interventions, anesthesia modalities, perioperative care, and outcomes. Descriptive statistics were used to report frequencies, percentages, and means. The study included predominantly male patients (78.5%) with a mean age of 29.6 years. Blast injuries (48.3%) and gunshot wounds (31.2%) were the leading causes of trauma. The most common injuries were femur fractures (36.5%) and acute open fractures (36.2%). Frequent procedures included open reduction and internal fixation (34.8%) and fixation device removal (29.0%). General anesthesia (32.3%) and spinal anesthesia (29.8%) were commonly used, and all patients received antibiotics (100.0%). Anticoagulants were administered to 47.5% of patients, and 92.3% received physiotherapy. Surgical complications were low (4.4%), with no recorded venous thromboembolism events or deaths within 9 months. Orthopedic trauma during the Gaza conflict was primarily characterized by blast and gunshot injuries, with femur fractures being most prevalent. These findings underscore the importance of targeted trauma care protocols and resource planning in conflict zones. Despite relatively low short-term complications, only 30.1% of patients regained independent ambulation at 3 months, underscoring a substantial early disability burden. The high incidence of complex injuries, incomplete follow-up, and cohort heterogeneity limit definitive conclusions, but the findings point to an urgent need for sustained international support for trauma care and rehabilitation systems in Gaza.

To compare the median effective dose (ED50) of prophylactic continuous infusion of metaraminol in parturients with different body mass index (BMI) undergoing cesarean delivery under spinal anesthesia, and to investigate the influence of maternal BMI on the required dose of metaraminol for preventing post-spinal hypotension, thereby providing a basis for clinical individualized medication. Eighty full-term singleton parturients scheduled for elective cesarean delivery at Suzhou Municipal Hospital Affiliated with Nanjing Medical University from July to September 2024 were selected and divided into a standard group (Group S, BMI < 30kg/m²) and an obese group (Group O, BMI ≥ 30kg/m²) based on BMI. All parturients underwent spinal anesthesia. Immediately after successful dural puncture, a continuous infusion of metaraminol was initiated. The initial dose for both groups was set at 2mg, with a concentration of 0.02mg/mL and a fixed infusion rate of 100 mL/h. The sequential method was used to adjust the dose for subsequent parturients, with a dose gradient of 0.05mg: if the previous parturient developed hypotension, the dose for the next parturient was increased by 0.05mg; if hypotension did not occur, the dose for the next parturient was decreased by 0.05mg. Hypotension was defined as a systolic blood pressure (SBP) decrease of ≥ 20% from baseline or SBP < 90 mmHg. Probit regression analysis was used to calculate the ED50 and 95% confidence interval (95% CI) of metaraminol for both groups. The ED50 and 95% CI of metaraminol for preventing post-spinal hypotension in Group S was 1.84mg/h (95% CI: 1.76-1.89mg/h); the corresponding value for Group O was 2.28mg/h (95% CI: 2.19-2.43mg/h). The relative potency ratio between Group O and Group S was 1.24. There were no statistically significant differences in the incidence of maternal adverse reactions or fetal umbilical cord blood gas analysis parameters between the two groups . The dose of metaraminol required to prevent hypotension after spinal anesthesia for cesarean delivery is influenced by maternal BMI. Obese parturients (BMI ≥ 30kg/m²) require a higher dose of metaraminol. Therefore, it is reasonable to individualize the prophylactic dose of metaraminol based on maternal weight (BMI) in clinical practice. The trial protocol was registered in the Chinese Clinical Trial Registry on June 29, 2024, with the registration number ChiCTR2400086366.

Optimized perioperative analgesia is a critical component of Enhanced Recovery After Surgery (ERAS) pathways in robotic-assisted laparoscopic hysterectomy (RALH). In high-volume robotic programs, predictable pain control may influence early mobilization, postoperative stability, and discharge planning. This study evaluated the analgesic efficacy and safety of two low-dose intrathecal morphine (ITM) regimens (0.10mg vs. 0.15mg) in patients undergoing RALH. We conducted a retrospective dual-center cohort study including 100 women who received spinal anesthesia with 0.10-0.15mg of preservative-free intrathecal morphine, with or without levobupivacaine, prior to general anesthesia for RALH. Postoperative pain was assessed using the Visual Analog Scale (VAS) at three time points (PACU arrival, PACU discharge, and 24h postoperatively). Rescue opioid use, hemodynamic events, postoperative nausea and vomiting (PONV), pruritus, and recovery parameters (Alderete Score) were recorded. Comparative analyses were performed between the two ITM dose groups. Pain scores remained consistently low across all time points (median VAS = 0; p = 0.302), with rescue analgesia required in 7% of patients (n = 7/100). Compared with the 0.10mg group, the 0.15mg group demonstrated significantly lower pain scores and reduced supplemental opioid requirements. Higher rates of pruritus, PONV, and hypotensive episodes were observed in the 0.10mg group. No cases of respiratory depression or prolonged PACU stay were recorded. Median Alderete Scores were consistently optimal (10/10), indicating stable postoperative recovery. Low-dose intrathecal morphine provides effective, opioid-sparing, and motor-preserving analgesia in robotic-assisted laparoscopic hysterectomy. In this cohort, the 0.15mg regimen was associated with improved analgesic balance without an increase in clinically significant adverse events. Within ERAS-based robotic pathways, optimized intrathecal morphine dosing may support predictable recovery and perioperative stability. Observational design precludes causal inference. Prospective randomized studies are warranted to confirm these findings. The Ethics Committee approved the study (Protocol ID 3307/2020) on July 6th, 2020, and it was registered in clinicaltrial.gov (NCT07169604).

BackgroundHip fractures (HF) are a serious and increasingly common condition in the geriatric population. Favorable clinical outcomes require early postoperative rehabilitation, which relies on effective pain management. Intrathecal morphine (ITM) is a well-established method of perioperative analgesia, but concerns have been raised about potential adverse effects in the elderly population. This superiority trial was designed to compare the efficacy and safety of low-dose intrathecal morphine, with adverse effect prevention, versus a standard multimodal analgesic regimen in elderly patients undergoing surgery for hip fracture repair.MethodsPatients aged 60–90 years scheduled for HF surgery under single spinal anesthesia were randomized into two groups: bupivacaine/levobupivacaine with 100 µg ITM, and bupivacaine/levobupivacaine alone. The primary outcome was pain intensity (11-point numeric rating scale; NRS) during the first 24 hours after surgery. Secondary outcomes included postoperative analgesic consumption, time to first analgesic, and incidence and severity of adverse effects.ResultsThis study enrolled 82 patients; 47 (57.3%) were allocated to the intervention group, 34 (41.5%) to the control group. The median 24-hour postoperative NRS score was 0.39 (IQR 0.00–0.90) in the intervention group, and 1.70 (IQR 1.23–1.91) in the control group (p < 0.001). Time to first analgesic was 16.5 hours (IQR 8.75–24.00) in the intervention group, and 7 hours (IQR 4.62–9.88) in the control group (p < 0.001). No postoperative analgesics were required for 29.8% of patients in the intervention group, and 2.9% of patients in the control group (p = 0.001). The incidence and severity of adverse effects did not significantly differ between the groups.ConclusionCompared to standard multimodal analgesia, low-dose ITM significantly reduced postoperative pain and analgesic consumption, and prolonged the time to first analgesic administration, without an increased incidence or severity of adverse effects in elderly patients with HF.

Leveraging micro-disk array device for sensitive duloxetine detection in human urine.

Spinal anesthesia in older patients can be technically challenging due to degenerative spinal disease. The L5-S1 interspace often remains accessible and is a useful fallback; however, it has been associated with higher rates of therapeutic failure due to inadequate block height. Injection of hypobaric local anesthetic may promote cranial intrathecal spread and address this limitation. We investigated this by evaluating the efficacy and block characteristics of low-dose hypobaric bupivacaine injected at the L5-S1 level in a prospective observational study. Fifty-four patients undergoing elective total hip or knee arthroplasty received ultrasound-assisted spinal anesthesia at L5-S1 with 10 mg of 0.33% hypobaric bupivacaine. The primary outcome was surgical completion without conversion to general anesthesia, supplemental opioids, or local anesthetic infiltration. Secondary outcomes included adequate anesthesia for surgical incision, block pharmacodynamics, hemodynamic stability, adverse effects, patient satisfaction, and surgeon-perceived quality of anesthesia. Surgical completion without anesthetic supplementation was successful in 50 patients (92.6%, 95% CI 82.1-97.8%). Adequate anesthesia for surgical incision was achieved in 53 patients (98.2%, 95% CI 90.1-100%). Four patients required supplemental opioids: one for surgical incision, and three for surgical completion following prolonged injection-to-incision intervals (47-59 minutes) due to unanticipated delays in operating room readiness. No patients required conversion to general anesthesia. Full motor recovery occurred within 198 ± 53 minutes. Patient and surgeon satisfaction with quality of anesthesia was high. Hypobaric 0.33% bupivacaine injected at L5-S1 may be a useful fallback option in lower-extremity arthroplasty if challenging spinal anatomy renders other interspaces inaccessible.

Effect of perioperative fluid therapy on urinary biomarkers in preeclamptic women who underwent caesarean section - A randomised controlled trial.

Postoperative pain management for total hip arthroplasty (THA) remains an area for improvement. This study compared the impact of suprainguinal fascia iliaca block (FIB) versus local anaesthetic infiltration (LAI), versus pericapsular nerve group (PENG) block, and versus spinal anaesthesia alone, on early postoperative pain in patients who underwent inpatient primary THA. This was a single-centre, assessor- and participant-blinded randomized controlled trial. A total of 240 patients undergoing THA under spinal anaesthesia were randomized to LAI, FIB, PENG block, or control in a 1:1:1:1 ratio. The primary outcome was pain at four hours postoperatively (visual analogue scale (VAS)). Secondary outcomes included VAS at other timepoints, opioid consumption, patient satisfaction, and length of hospital stay (LOS). A VAS difference of 2 cm was considered clinically significant. A total of 240 participants were randomized, with 222 in the final analysis. Only LAI (mean VAS 1.6 (SD 2.2)) significantly decreased postoperative pain compared with the control group (mean VAS 3.0 (SD 2.7); p = 0.004) at four hours. VAS at four hours was not significantly different between LAI, FIB, and PENG block groups in direct comparisons. FIB (23.3 mg morphine equivalents (MEQ) (SD 18.4), p = 0.001) and LAI (22.2 mg MEQ (SD 18.7), p = 0.001) significantly decreased opioid consumption compared with the control group (36.7 mg MEQ (SD 24.5)) at 24 hours postoperatively. The same was found at 48 hours postoperatively. LAI significantly improved patient satisfaction scores at four hours compared with the control group (1.3 (SD 0.6) vs 1.9 (SD 1.2), p = 0.043). There was no difference in LOS between study groups. One patient had femoral nerve motor deficit following PENG block, with full recovery at six months postoperatively. LAI combined with spinal anaesthesia reduced early postoperative pain and improved patient satisfaction with pain control compared with spinal anaesthesia alone. LAI and FIB both decreased opioid consumption in the first 24 and 48 hours.

Effective postoperative pain management is essential for optimizing recovery after partial hip replacement surgery, particularly in elderly patients with multiple comorbidities. The quadroiliac plane block (QIPB) is a recently described ultrasound-guided fascial plane block that targets the fascial plane beneath the quadratus lumborum muscle at the inner iliac crest, with potential to provide extensive periarticular coverage. Thirty adult patients were randomized to receive either a unilateral QIPB (40 mL 0.25% bupivacaine) or no block following surgery under spinal anesthesia. All patients received standardized multimodal analgesia including IV fentanyl PCA and paracetamol. The primary outcome was total fentanyl consumption in the first 24 hours. Secondary outcomes included pain scores at 1, 6, 12, and 24 hours; rescue analgesia requirements; postoperative nausea and vomiting (PONV); dermatomal spread; and Quality of Recovery-15 (QoR-15) scores. Median fentanyl consumption was significantly lower in the block group (100 µg [IQR 80-120]) compared to control (300 µg [IQR 270-360]; P<0.001). NRS pain scores were significantly lower at 1, 6, and 12 hours (P<0.01), but not at 24 hours. QoR-15 scores were higher and PONV and rescue analgesia rates were lower in the block group. Dermatomal mapping showed consistent L1-L5 coverage, with cranial extension to T10-T12 and caudal spread to S1-S2 in most patients. No block-related complications were observed. QIPB provides reliable and opioid-sparing analgesia with extensive sensory coverage, representing a safe and effective regional technique to optimize recovery after partial hip replacement surgery.

The number of pregnant women with adult congenital heart disease (ACHD) is increasing, posing growing challenges for obstetric anaesthesia. This study analysed anaesthetic strategies and postoperative care in ACHD patients treated at atertiary care centre. This retrospective single-centre study included ACHD patients who received anaesthesia for delivery, caesarean section or obstetric surgery between 2004 and 2023. Acomparison group of obstetric patients without congenital heart disease was selected based on baseline characteristics. Atotal of 391 cases were included (131 ACHD, 260 comparison group). Most patients were classified as mWHOI (44.2%) orII (23.8%), with 20.5% mWHO II-III and 11.5% mWHO III and IV. Spinal and epidural anaesthesia were used more frequently in lower mWHO classes (p = 0.017). All mWHOIV patients required general anaesthesia provided by ACHD-experienced anaesthetists. ACHD patients more frequently required postoperative ICU or IMCU care (6.6% vs.1.6%, p = 0.02; 13.9% vs.3.7%, p < 0.001). Anaesthesiologic complication rates were low in both groups. Obstetric anaesthesia was feasible with low complication rates, even in severe ACHD, when management was individualised and interdisciplinary. All anaesthetic procedures proved to be feasible when adapted to the risk profile.

Despite advancements in perioperative pain treatment for elective orthopaedic surgery, significant postoperative pain remains. Postoperative pain is a factor that influences recovery and hospital stay after prosthetic orthopaedic surgery. Treatment modalities, such as nerve blocks, local infiltration analgesia, and opioids, have been attempted. Each treatment modality has its own distinct advantages and disadvantages. Intrathecal morphine was administered in accordance with PROSPECT recommendations. Given the discrepancies between our findings and the recommendations, we retrospectively analysed the effectiveness and side effects of intrathecal morphine in patients undergoing hip or knee replacement. A single-centre retrospective analysis. Large non-university teaching hospital. A total of 854 patients who underwent spinal anaesthesia for knee or hip replacement surgery between March 15, 2022, and August 31, 2023, with or without intrathecal morphine. Data, registered as part of standard clinical practice, were collected from 854 patients, of whom 414 had received intrathecal morphine. We collected pain scores on the day of the operation (day 0) and on the two days thereafter (days 1 and 2). Furthermore, side effects, including urinary retention requiring catheterization, nausea, vomiting, and itching, were studied. The pain scores were modestly, but significantly, lower on the day of the operation in patients receiving intrathecal morphine. However, on day two, the pain scores were modestly and significantly higher, in patients receiving intrathecal morphine. Additionally, patients in the spinal morphine group experienced more nausea, vomiting, and itching. Furthermore, they had an increased risk of catheterization in the univariate analysis (P < 0.05). After correction, there was an increased risk of catheterization in males only (odds ratio, 1.63; 95% confidence interval: 1.01-2.63; P = 0.04). The side effects of intrathecal morphine, with only a modest decrease in pain scores on the operation day, prompted us to stop administering intrathecal morphine for elective knee and hip replacement. This trial was registered in the Open Science Framework registry (https://osf.io/rt57a).

Background: Post-dural puncture headache (PDPH) is a common and distressing complication of spinal anaesthesia in obstetric patients. Needle gauge is a known modifiable risk factor influencing PDPH incidence and severity. Objective: To compare the incidence, severity, and perioperative characteristics of PDPH among parturients undergoing cesarean section using 25G versus 27G Quincke spinal needles. Methods: This prospective observational study was conducted at Anwar Khan Modern Medical College Hospital, Dhaka, Bangladesh, over a two-year period (January 2023–January 2025). A total of 400 patients were enrolled (200 in each group). PDPH cases were identified and analyzed for demographic, obstetric, and perioperative variables. Results: The incidence of PDPH was significantly higher in the 25G group (14%) compared to the 27G group (2%). Mild PDPH occurred in 50.0% of 27G cases vs. 3.6% in the 25G group (p = 0.0059). Although time to CSF flow was longer in the 27G group, and postoperative vomiting and vertigo were more frequent in 25G cases, these differences were not statistically significant. No significant hemodynamic changes were observed between groups. Conclusion: The 27G Quincke needle significantly reduces both the incidence and severity of PDPH without increasing procedural or clinical complications. Its adoption in obstetric spinal anaesthesia may enhance maternal outcomes and should be considered in local practice guidelines. Bangladesh J Obstet Gynaecol, 2025; Vol. 40(2): 91-100