Spinal Anesthesia Research Articles

Comparative Analysis of Intrathecal Bupivacaine With Fentanyl Versus Intrathecal Bupivacaine With Midazolam in Lower Abdominal and Lower Limb Surgeries.

Many different adjuvants are added intrathecally along with local anaesthetics to prolong intraoperative and postoperative analgesia. Hence, this study aimed to compare intrathecal bupivacaine with fentanyl and bupivacaine with midazolam in lower abdominal and lower limb surgeries. Following permission from the Hospital Ethical Committee (Research Protocol No.: IESC/PGS/2022/143), the study was conducted on a sample of 60 patients, divided into two groups, Group F and Group M, with 30 patients each, representing the American Society of Anaesthesiologist's (ASA) grades I and II. The patients were between the ages of 18 and 60 and featured both males and females, scheduled to undergo elective surgical procedures on the lower abdomen and lower limbs via spinal anaesthesia. Group "F": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (25 mcg) of fentanyl (preservative-free) intrathecally. Group "M": 3 ml of 0.5% hyperbaric bupivacaine hydrochloride with 0.5 ml (2.5 mg) of midazolam (preservative-free) intrathecally. The primary aim was to study the onset of motor and sensory block and duration of analgesia with the addition of midazolam or fentanyl to 0.5% heavy bupivacaine in the sub-arachnoid block. A secondary aim was to evaluate the quality of anaesthesia and postoperative analgesia, determine the haemodynamic stability in the intraoperative and postoperative period in the two study groups, andobserve any adverse effects of study drugs. Group F exhibited a substantially longer duration for both sensory (211.5 vs. 154.4 min) and motor blockade (269.8 vs. 214.6 min) compared to Group M, as well as a rapid onset time for both sensory (2.6 vs. 3.3 min) and motor blockade (3.1 vs. 3.9 min). Also, Group F had a significantly longer duration of effective analgesia compared to Group M (266 ± 15.9 vs. 197.6 ± 13.7 minutes). The addition of 0.5 ml (2.5 mg) Midazolam with 0.5% hyperbaric Bupivacaine intrathecally prolonged the duration of anaesthesia and postoperative analgesia; however, fentanyl 0.5 ml (25 mcg) has a more prolonged duration of intraoperative and postoperative analgesia.

Comparative Effectiveness of Regional Anesthesia and Nerve Block Techniques in Reducing Chronic Post-Surgical Pain in Adults Undergoing Inguinal Hernia Surgery: A Systematic Review

Background: This study to show about comparative effectiveness of regional anesthesia and nerve block techniques in reducing chronic post-surgical pain in adults undergoing inguinal hernia surgery. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: CPSP is a multifactorial and complex condition that can significantly affect the quality of life of patients undergoing surgery. General anesthesia plus ilioinguinal nerve block is better than spinal anesthesia (SA) regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients. Regional block anesthesia (RBA) is superior to conventional spinal anesthesia (CSA) for pain relief at 24 hours post-surgery.

A double blinded randomized prospective trial of comparison between control and study group, nefopam versus tramadol on shivering scores after spinal anesthesia in patients undergoing Transurethral resection of prostate

IntroductionShivering is a common and distressing complication that can occur after subarachnoid block (SAB) in patients, particularly those undergoing transurethral resection of the prostate (TURP) due to the use of irrigating fluid and older age group. This study aims to compare the effectiveness of nefopam and tramadol in reducing intraoperative shivering compared to a control group, in Indian patients. MethodologyThis study is a double-blinded randomized control trial with a total of 99 patients undergoing elective TURP under SAB were enrolled. The patients were randomly divided into three groups (GT, GN, and GC): GT received tramadol (0.5 mg kg-1) and GN received nefopam (0.15 mg kg-1). Both tramadol and nefopam were premixed into 100 ml of normal saline (NS) and GC received 100 ml NS, given over 15 min just before SAB. The induction protocol was the same for all groups, and shivering score, hemodynamic parameters, and body temperature (BT) were recorded. ResultsThe overall incidence of shivering was 29.67 % (27/91), with the lowest incidence being in GN (16.67 %, 5/30), followed by GT (22.58 %, 7/31) and GC (50 %, 15/30). Both nefopam and tramadol resulted in a significant (p < 0.05) decrease in the incidence of shivering compared to control. Among the hemodynamic parameters and BT, no significant difference was seen between GT, GN, and GC (p > 0.05). ConclusionBoth nefopam and tramadol were effective in reducing the incidence but the severity was controlled better with nefopam during TURP under SAB.

Comparative Analysis of Oral Clonidine Versus Oral Gabapentin on Subarachnoid Block Duration and Postoperative Analgesic Needs.

Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being. In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups. The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV). Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VASscores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct.

Anesthesia's Influence on Postoperative In-Hospital Morbidity-Mortality in Proximal Femoral Fractures in the Elderly.

Background and Objectives: The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)'s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. Materials and Methods: This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. Results: In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. Conclusions: We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist's preference.

Anestesias de pacientes de alto risco durante a abordagem cirúrgica: Estratégias adaptadas para pacientes com comorbidades

Introduction: The anesthetic management of high-risk patients, especially those with significant comorbidities, represents an important clinical challenge. This study reviews the anesthetic strategies adapted for these patients, focusing on interventions that can minimize perioperative complications and improve surgical outcomes. Methods: Studies published between 2010 and 2024 were analyzed, using databases such as PubMed, Scielo, and the Brazilian Journal of Anesthesiology. The review included randomised controlled trials that compared different anaesthetic techniques and their implications for high-risk patients. Studies without a control group were excluded from the analysis. Results: The results indicated that patients at high risk of obstructive sleep apnea have a higher incidence of adverse respiratory events, which highlights the importance of specific anesthetic strategies for this population. Pressure-controlled volume-assured ventilation (PCV-VG) was superior to volume-controlled ventilation (VCV) in obese patients undergoing laparoscopic surgery in the Trendelenburg position, providing better ventilatory parameters and oxygenation. Costoclavicular block has been identified as an effective and safe technique for upper limb anesthesia in obese patients, reducing the need for general anesthesia. In cardiac surgeries, glucose-insulin-potassium (GIK) administration has been shown to be beneficial, reducing adverse cardiac events and improving hemodynamic stability. Finally, spinal anesthesia has been shown to be preferable to general anesthesia in lumbar spine surgeries for high-risk patients, promoting greater intraoperative stability. Conclusion: It is concluded that the personalization of anesthetic strategies is essential to optimize the management of high-risk patients, taking into account individual characteristics and comorbidities. Careful choice of anesthetic techniques can minimize complications, improve postoperative outcomes, and ensure a safer recovery. The integration of new evidence and the adoption of multidisciplinary approaches are essential to improve perioperative care and promote better outcomes in complex and vulnerable patients.

Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.

Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.

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.

The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial.

Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant. Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported. Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

Effect of hydroxyethyl starch (Voluven ® 6% 130/0.4) on blood glucose levels during orthopaedic lower limb surgery under spinal anaesthesia – a prospective, randomised controlled trial

Effect of hydroxyethyl starch (Voluven ^® 6% 130/0.4) on blood glucose levels during orthopaedic lower limb surgery under spinal anaesthesia – a prospective, randomised controlled trial

The Effect of Anesthesia Method on Melatonin Level and Its Relationship With Postpartum Depression ın Cesarean Section Patients.

Objective Our studyaimed to establish the effects of anesthetic agents used in cesarean sections on melatonin levels and to evaluate the possible association between melatonin levels and postpartum depression. Materials and methods Our study was approved by the Erzincan Binali Yıldırım University Ethics Committee (approval number: 25.07.2017 11/11). We included 231 pregnant women between the ages of 18 and 45 who were admitted for a cesarean section to Erzincan Mengücek Gazi Training and Research Hospital Anesthesiology and Reanimation Clinic. The pregnant women were divided into three groups that underwent general, spinal, and combined spinal-epidural anesthesia, respectively. These approaches were determined by the preference of the attending anesthesiologist. On the postoperative first day at 5:00 am, peripheral venous blood samples were obtained from the subjects for melatonin level measurement. Samples were centrifuged and kept in -80 °C until the testing for melatonin with the enzyme-linked immunosorbent assay (ELISA) method. In order to determine the depression status, the subjects were evaluated with the Edinburgh Postpartum Depression Scale. Results Of all the anesthesia typesgiven to the subjects, 16% was combined spinal-epidural anesthesia, 18.2% was general anesthesia, and 65.8% was spinal anesthesia. According to the scale, 68% of the subjects had no depression and 32% had depression. The depression rate in subjects who underwent general anesthesia was significantly higher than in other groups (p<0.001). The association between the anesthesia method and melatonin levels had no statistically significant difference (p=0.53). The association between depression status and melatonin levels had no statistically significant difference among the two groups (p=0.097). Conclusion We aimed to evaluate the effect of the chosen anesthesia method on postoperative melatonin levels and postpartum depression and found that the chosen method of anesthesia does not affect postoperative melatonin levels significantly but the usage of general anesthesia significantly raises the postpartum depression rate among subjects. We also did not find any correlation between postoperative melatonin levels and postpartum depression.

Comparison Of Passive Leg Raising And Intravenous Phenylephrine As Prophylaxis In Prevention Of Hypotension After Spinal Anaesthesia In Elective Caesarean Section - A Randomised Controlled Study

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Postoperative Outcomes of the Awake Colorectal Surgery with Neuraxial Anaesthesia.

To determine the outcome of awake surgery with combined spinal epidural in geriatric colon cancer patients with advanced comorbidity. Quasi-experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye, from April 2022 to 2023. Twenty-four American Society of Anaesthesiologists (ASA) I-II patients, aged 25-65 years and scheduled for colon cancer surgery were included in this research. All patients were observed preoperatively, at the operation room and at the postoperative surgery service. Spinal anaesthesia was planned for Group I and general anaesthesia for Group II. Ketofol (1:1) was administered to the combined spinal-epidural group, with a Ramsay sedation score of 3 after the spinal block. Epidural analgesia was planned for all patients. Patients' age, gender, weight, comorbidities, ASA risk scores, intraoperative haemodynamic parameters, bleeding amounts, colloid, crystalloid, and blood products were collected. There was no significant difference between the demographic characteristics of both anaesthesia groups (p >0.05). The amount of bleeding was statistically lower in Group I than in the general anaesthesia group (p = 0.004). Oral intake, drain withdrawal, mobilisation, discharge times, and costs were similar in all groups (p >0.05). The regional anaesthesia applications facilitate compliance with routine mobilisation, discharge procedures and prevent complications in abdominal surgery and its positive perioperative effects in patients with poor respiratory parameters, poor general condition, and high comorbidity in advanced age. Regional anaesthesia, Spinal-epidural, Mobilisation, Pain, Colon cancer.

Investigation and Evaluation of Blood Pressure after Spinal Anesthesia

Investigation and Evaluation of Blood Pressure after Spinal Anesthesia

Intrathecal Dexmedetomidine as an Adjuvant to Low Dose Hyperbaric 0.5% Bupivacaine on Haemodynamic Parameters in Patients Undergoing Transurethral Resection of Prostate.

To determine the role of dexmedetomidine in potentiating the local anaesthetic efficacy of a low dose of bupivacaine when used as an adjuvant. A prospective, double-blind, randomised study. Place and Duration of the Study: Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from July 2021 to February 2022. One hundred and eight patients of ASA physical class I-III undergoing transurethral resection of the prostate (TURP) under sub-arachnoid block (SAB) were enroled and distributed into two equal groups. Group BUPIPURE (BP) was given 7.5 mg of pure 0.5% hyperbaric bupivacain whereas group BUPIDEX (BD) was given 6 mg of 0.5% hyperbaric bupivacain with 3 μg dexmedetomidine intrathecally. The effects in Both groups were compared using chi-square and unpaired t-tests. A significance level of p <0.05 was used to evaluate the statistical significance. Both groups demonstrated a steady decrease in mean heart rate (mean HR 98.9-62.7 per minute as compared to 79.1-59.4 per minute in groups BP and BD, respectively), however, no patient reached to HR <50/min. Group BP had a higher HR variability than group BD. The two groups' median peak sensory levels were similar. However, a statistically significant difference was revealed in the time taken for 2-segment regression (87.5 ± 11.3 min vs. 115.5 ± 6.2 min p <0.001 in BP and BD), as well as the time to reach T10 sensory level (13.56 ± 2.5 min vs. 10.9 ± 3.0 min p <0.001). In patients having TURP, intrathecal dexmedetomidine combined with low-dose bupivacaine results in a quicker start, extended sensory and motor block, and a decreased need for rescue analgesics. Adjuvants, Dexmedetomidine, Spinal anaesthesia, Transurethral Resection of Prostate.

Reply to comments regarding 'efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after cesarean delivery under spinal anaesthesia: A non-randomised clinical trial'.

Reply to comments regarding 'efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after cesarean delivery under spinal anaesthesia: A non-randomised clinical trial'.

Post-Operative Urinary Retention Beyond Spinal Anesthesia

Post-Operative Urinary Retention Beyond Spinal Anesthesia

Comparison of Hemodynamic and Recovery Profile Between Segmental Thoracic Spinal and General Anesthesia in Upper Abdominal and Breast Surgeries: A Systematic Review and Meta-Analysis.

Segmental thoracic spinal anesthesia (STSA) has been described primarily as case reports for performing upper abdominal and thoracic surgeries in significant respiratory comorbid patients. A few comparative studies have recently evaluated the technique as an advantageous alternative to general anesthesia (GA). However, there is no systematic evaluation and comparison of the techniques. The present systematic review evaluated the hemodynamic, comfort, and satisfaction of patients undergoing abdominal and thoracic surgeries under STSA and GA. PubMed, CENTRAL, Google Scholar Advanced, and citation tracking were performed to find suitable articles that compared STSA and GA. The primary objective-related data were hypotension and bradycardia. The secondary objective-related data in the context of postoperative nausea vomiting (PONV), pain, rescue analgesics, sedation requirement, satisfaction, and comfort were assessed. Meta-analysis was performed for dichotomous data on hypotension, bradycardia, and PONV; odds ratio (OR) and 95% confidence interval (CI) were reported. Data of 394 patients from six studies were evaluated. Patients undergoing upper abdominal and breast surgeries under STSA had significantly higher odds of hypotension (Fixed-Effect Model OR 12.23, 95% CI 2.81-53.28; I2 =0%, and the Random Effects Model OR 12.01, 95% CI 2.75-52.52; I2 =0%) and bradycardia (Fixed-Effect Model OR 10.95, 95% CI 2.94-40.74, I2 =0%, and the Random Effects Model OR 9.97, 95% CI 2.61-38.08; I2 =0%) but lower odds of PONV (Fixed-Effect Model OR 0.24, 95% CI 0.13-0.43; I2 =0%, and the Random Effects Model OR 0.24, 95% CI 0.13-0.45; I2 =0%). Most of the patients undergoing STSA were given intravenous sedation to overcome anxiety and discomfort. Overall, patient satisfaction was on par with GA. However, few surgeons were unenthusiastic about the technique while performing axillary clearances due to bothering twitches from cautery. STSA led to early post-anesthesia care unit (PACU) discharge and provided better pain control, lowering the need for rescue analgesics and opioid consumption in the first 24-hour postoperative period. STSA is associated with very high odds of hypotension and bradycardia as compared to GA. On the other hand, STSA demonstrated superior pain control, reduced opioid requirements, shorter PACU stays, and significantly reduced risk of PONV. Nevertheless, STSA patients mostly require sedation to make the patient comfortable.

Optimizing Regional Anesthesia for Cancer Patients: A Comprehensive Review of Current Practices and Future Directions.

Regional anesthesia has emerged as a pivotal component in the perioperative management of cancer patients, offering several advantages over traditional general anesthesia. By providing targeted pain relief and minimizing systemic exposure to opioids, regional anesthesia reduces the risk of opioid-related side effects and enhances postoperative recovery. Regional anesthesia may positively influence oncological outcomes by attenuating the surgical stress response and preserving immune function, potentially reducing cancer recurrence and metastasis. This review comprehensively explores the current practices and benefits of regional anesthesia in the oncology setting, including various techniques such as nerve blocks, epidural anesthesia, and spinal anesthesia. It examines the challenges associated with its application in cancer patients, including technical difficulties and patient-related factors. It evaluates the existing evidence regarding its impact on cancer progression and patient survival. Additionally, the review discusses future directions in the field, emphasizing the need for personalized anesthesia strategies, further research into the long-term effects of regional anesthesia on cancer outcomes, and the development of innovative approaches to enhance its efficacy and safety. By addressing these areas, this review aims to provide a thorough understanding of how to optimize regional anesthesia for cancer patients, ultimately contributing to improved perioperative care and better long-term outcomes.

Dexamethasone and Lidocaine Effects in 24 hours Post Cesarean Pain Reduction under Spinal Anesthesia: A Randomized Controlled Trial

Objective: This study aimed to compare the efficacy of additional local infiltration of dexamethasone and lidocaine among post-cesarean parturient underwent spinal anesthesia compared to the control group. Materials and Methods: This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between June and November 2022. Singleton pregnant women who underwent cesarean delivery were randomized into 3 groups: dexamethasone (D), lidocaine (L), and control groups (C). Before skin closure, D, L and C group received infiltration of 16 mg of dexamethasone, 2% lidocaine with adrenaline and none, respectively. A visual analog scale (VAS, 0-10) was used for the evaluation of post-cesarean pain at two, four, six, eight, twelve, and twenty-four hours. VAS, demographic, and obstetric data were collected for analysis. Additional opioid was recorded for secondary outcome. Results: A total of 279 participants were recruited and divided into 3 groups. Half of the participants (151/279) were nulliparity. Other demographics were similar. Subjects in the D group had lower moderate to severe pain after 6 hours onwards and less additional opioid requirement compared to the C and L groups significantly. Subjects in the L group had lower moderate to severe pain than the C group at 4 hours after surgery. Postoperative complications were comparable among the groups. Conclusion: Local dexamethasone infiltration could reduce and prolong post-cesarean pain relief within 24 hours after cesarean delivery.