Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses.

Background: Cesarean delivery is commonly performed under either spinal or general anesthesia. While both techniques are widely used, their differential effects on maternal neurochemical profiles, particularly excitatory neurotransmitters such as glutamate, remain incompletely understood. Glutamate plays a central role in stress response, nociception, and neuroendocrine regulation. This study aimed to compare maternal salivary glutamate concentrations between spinal and general anesthesia during cesarean delivery. Method: In this prospective study, 66 women undergoing cesarean delivery were included: 32 received spinal anesthesia and 34 received general anesthesia. Unstimulated saliva samples were collected perioperatively and analyzed using a colorimetric enzymatic assay. Clinical and demographic variables were extracted from electronic medical records. Results: Baseline maternal and neonatal characteristics were comparable between groups (all p > 0.05). Glutamate concentrations were not normally distributed. Median salivary glutamate levels were significantly higher in the general anesthesia group compared with the spinal anesthesia group (8.05 nmol/µL [IQR 4.81–11.69] vs. 5.19 nmol/µL [IQR 3.05–8.39]; p = 0.041) After adjustment for maternal and perinatal covariates, anesthesia type was not independently associated with glutamate levels (p = 0.21). Conclusion: General anesthesia was associated with higher unadjusted maternal salivary glutamate levels compared with spinal anesthesia during cesarean delivery; however, this association did not persist after multivariable adjustment. These findings suggest that anesthesia technique alone may not independently influence perioperative glutamatergic responses. Further research is warranted to clarify the clinical significance of these neurochemical changes for maternal and neonatal outcomes.

Background: Substance P is a key neuropeptide involved in the transmission of nociceptive (pain) signals. The choice of anesthesia for childbirth, particularly for cesarean section (CS), is a critical decision that directly impacts the mother’s physiological response to the procedure. This study aims to compare the levels of salivary SP in pregnant women undergoing CS under spinal versus general anesthesia. Methods: Eighty-three patients participated in this prospective comparative study. They were categorized into two groups: general and spinal anesthesia groups. The primary outcome was to measure the mean difference in salivary substance P level at three different time points of CS, and to compare these values between both groups. The secondary outcome was to assess the factors affecting the substance P levels in the mothers. Results: The study included 44 (53%) who received spinal anesthesia and 39 (47%) who received general anesthesia. Median substance P levels were significantly higher in the spinal anesthesia group (761 pg/mL [IQR 532– 1335]) compared with the general anesthesia group (409 pg/mL [IQR 118– 1094]; U = 1188.0, p = 0.0026). On multiple regression analysis, type of anesthesia was the independent variable influenced the levels of salivary substance P. Conclusion: This study demonstrates that participants receiving spinal anesthesia have significantly higher salivary substance P levels compared to those undergoing general anesthesia for CS. Further research is needed to understand the mechanisms underlying this observation and to determine its clinical implications for maternal and neonatal outcomes.

Introduction: Labor pain is among the most intense forms of acute pain, mediated in part by excitatory glutamatergic neurotransmission within central nociceptive pathways. Glutamate plays a key role in spinal dorsal horn signaling and central sensitization, yet its peripheral dynamics during labor and in response to different analgesic modalities remain unclear. This exploratory study aimed to evaluate whether maternal salivary glutamate levels differ between epidural labor analgesia and systemic morphine analgesia during normal vaginal delivery. Method: In this observational comparative study, 36 women were selected to either epidural analgesia (n = 16) or systemic morphine analgesia (n = 20). Salivary samples were collected during active labor and analyzed for glutamate concentration using a validated enzymatic colorimetric assay. Clinical and demographic data were recorded. Non-parametric tests were applied due to non-normal distribution of glutamate levels. Results: Baseline maternal and perinatal characteristics were comparable between groups. Median salivary glutamate levels were higher in the epidural group than in the morphine group (5.32 nmol/µL [IQR 2.83–8.00] vs. 3.99 nmol/µL [IQR 2.26–8.03]), but the difference was not statistically significant (p = 0.599). Glutamate concentrations showed marked inter-individual variability (0.14–29.89 nmol/µL) and a right-skewed distribution. No significant associations were observed between glutamate levels and maternal age, Body Mass Index, gestational age, birth weight, or obstetric comorbidities. Conclusion: In this exploratory cohort, maternal salivary glutamate concentrations did not differ significantly between epidural labor analgesia and systemic morphine analgesia during labor. The variability observed suggests complex and heterogeneous regulation of peripheral glutamatergic activity in parturition. Further larger-scale studies integrating central and peripheral measurements are warranted.

Background: The influence of obstetric anesthesia on neonates is still under investigation. We aimed to investigate the influence of type of anesthesia; either general anesthesia (GA) or spinal anesthesia (SA); during elective or emergency cesarean section (CS) on neonatal outcomes. Methods: A retrospective cohort study was conducted and all neonatal admissions to the neonatal intensive care unit for mothers who underwent elective or emergency CS as the mode of delivery during the period from 2017 to 2021 were enrolled in the study. The primary outcome of the study was to investigate the difference between SA and GA. The enrolled cohort was divided into two groups: GA and SA groups. Results: A total of 997 patients were included in the study cohort. Among these, 628 patients underwent CS under SA. On univariate analysis, it was revealed that SA was associated with better Apgar score (8.56 ± 0.04 vs 8.16 ± 0.05, P =0.0001), less incidence of respiratory distress syndrome (RDS) (35.5% vs 42.3%, P =0.02), intraventricular hemorrhage (IVH) (0.8% vs 13.6%, P =0.0001), and neonatal thrombocytopenia (12.4% vs 17.3%, P =0.021). Moreover, GA was linked to higher mortality rates (10.8% vs 4%, P =0.0001) and more birth depression (10.6% vs 4.3%, P =0.0001). On the other hand, GA was related to less incidence of transient tachypnea of the newborn (TTN) (6.2% vs 12.6%, P =0.001). On multivariate logistic regression analysis, mode of anesthesia was related to RDS, TTN, IVH, birth depression and neonatal death. Conclusion: GA use may be related to more adverse and worse neonatal outcomes. This is related to the utilization of GA more frequently in higher-grade emergencies and is associated with more adverse baseline predictors including lower gestational age, lower birth weight, and greater obstetric complications. SA could offer a localized effect for the anesthetic drugs. Further prospective trials are needed to justify the risk of both types of anesthesia.