Background: Adequate pain management for abdominal hysterectomy is a key factor to decrease postoperative morbidity, hospital length of stay and chronic pain. General anesthesia is still the most widely used technique for abdominal hysterectomy. The aim of this study was to assess the efficacy and safety of blended anesthesia (spinal and general anesthesia) compared to balanced general anesthesia in patients undergoing hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. Methods: We retrospectively collected data from adult ASA 1 to 3 patients scheduled for laparoscopic or mini-laparotomic hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. Exclusion criteria were age below 18 years, ASA > 3, previous chronic use of analgesics, psychiatric disorders, laparotomic surgery with an incision above the belly button and surgery extended to the upper abdomen for the presence of cancer localizations (e.g., liver, spleen or diaphragm surgery). The cohort of patients was retrospectively divided into three groups according to the anesthetic management: general anesthesia and spinal with morphine and local anesthetic (Group 1), general anesthesia and spinal with morphine (Group 2) and general anesthesia without spinal (Group 3). Results: NRS was lower in the spinal anesthesia groups (Groups 1 and 2) than in the general anesthesia group (Group 3) for every time point but at 48 h. The addition of local anesthetics conferred a small but significant NRS decrease (p = 0.009). A higher percentage of patients in Group 3 received intraoperative sufentanil (52.2 ± 18 mcg in Group 3 vs. Group 1 31.8 ± 16.2 mcg, Group 2 44.1 ± 15.6, p < 0.001) and additional techniques for postoperative pain control (11.4% in Group 3 vs. 2.1% in Group 1 and 0.8% in Group 2, p < 0.001). Intraoperative hypotension (MAP < 65 mmHg) lasting more than 5 min was more frequent in patients receiving spinal anesthesia, especially with local anesthetics (Group 1 25.8%, Group 2 14.6%, Group 3 11.6%, p < 0.001), with the resulting increased need for vasopressors. Recovery-room discharge criteria were met earlier in the spinal anesthesia groups than in the general anesthesia group (Group 1 102 ± 44 min, Group 2 91.9 ± 46.5 min, Group 3 126 ± 90.7 min, p < 0.05). No differences were noted in postoperative mobilization or duration of ileus. Conclusions: Intrathecal administration of morphine with or without local anesthetic as a component of blended anesthesia is effective in improving postoperative pain control following laparoscopic or mini-laparotomic hysterectomy, in reducing intraoperative opioid consumption, in decreasing postoperative rescue analgesics consumption and the need for any additional analgesic technique. We recommend managing postoperative pain with a strategy tailored to the patient’s physical status and the type of surgery, preventing and treating side effects of pain treatments.

Background: Variability in obstetric outcomes in terms of the number and type of deliveries related to the day–night cycle has been described in previous studies. This 11-year retrospective analysis explores the effects of nighttime versus daytime delivery with labor epidural on obstetric outcomes. Methods: Data on deliveries performed between 1 October 2008 and 1 October 2019 were collected and differentiated into daytime, occurring from 8:00 a.m. to 7:59 p.m., and nighttime deliveries, occurring from 8:00 p.m. to 7:59 a.m. of the following day. The data collected included the patient history and maternal and neonatal outcomes. Results: A total of 29831 patients were included in the analysis. A positive and statistically significant correlation between the number of cesarean sections (Odds Ratio 1.35; 95% confidence interval = 1.26–1.44; p < 0.001) and the number of vaginal operative deliveries (Odds Ratio 1.21; 95% confidence interval = 1.01–1.44; p < 0.05) in patients who did not receive an epidural at nighttime was reported. Regarding the labor epidurals, a significantly greater incidence of accidental dural punctures with needles (0,4%; p < 0.05) in the nighttime versus daytime was reported. Conclusions: The absence of labor epidurals was associated with a significant increase in the number of cesarean sections and vaginal operative deliveries occurring at nighttime, without significant differences in labor duration. The incidence of anesthesiologic complications was greater in deliveries performed at nighttime.

Background/Objectives: Spinal anesthesia (SA) for elective cesarean delivery (CD) is frequently complicated by maternal hypotension, predominantly attributed to arterial vasodilation and venous pooling. The precise hemodynamic derangements are complex and poorly characterized. We aimed to describe continuous, non-invasively measured maternal hemodynamics changes during CD under SA, focusing on myocardial cardiac contractility (dP/dtmax) and stroke volume index (SVI), and their association with hypotensive episodes. Methods: 95 healthy pregnant women were included. Continuous non-invasive hemodynamic monitoring was performed using a finger-cuff system. We analyzed the incidence, duration, and time-weighted averages (TWA) area under the threshold of hypotension (Mean Arterial Pressure - MAP - <65 mmHg for ≥1 minute), reduced cardiac contractility (dP/dtmax <400 mmHg/sec), and low flow states (SVI <35 mL/b/m2). Results: The median TWA-MAP < 65 mmHg was 0.55 (0.21, 1.13) mmHg, with 2 (1, 5) hypotensive events per patient. Median duration of hypotensive events per patient was 4 (2, 17) min, corresponding to a 5 (2, 15) % of the total monitoring time. Sixty patients (63%) showed a reduced cardiac contractility that averaged 346 (326, 366) mmHg/sec. In 30 patients (31%) at least 1 episode of hypotension (MAP 1 minute) was associated with reduced cardiac contractility and a low flow state. In 11 parturients (11%) hypotension was associated to reduced myocardial contractility, while in 8 patients (8%) to low flow alone. Only 9 patients (9%) maintained normal values across all three hemodynamic parameters assessed. No significant correlation emerged between age, body mass index, TWA-MAP, TWA-SVI and TWA-dP/dtmax. Conclusions: Reduced cardiac contractility and low flow states during CD under SA are frequent, but individual expression and the consequent blood pressure decline vary widely. Continuous non-invasive monitoring provides critical, real-time physiological insights that could facilitate individualized, hemodynamically targeted therapies in obstetric anesthesia.