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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 18130

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Prof. Dr. Gaetano Draisci

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Guest Editor

Unit of Obstetric, Gynecologic Anesthesia and Pain Medicine, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
Interests: anesthesia; obstetrics; gynecology; pain

Dr. Stefano Catarci

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Guest Editor

Unit of Obstetric, Gynecologic Anesthesia and Pain Medicine, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
Interests: anesthesia; obstetrics; gynecology; pain

Special Issue Information

Dear Colleagues,

Pain perception and its expression vary by gender and other factors. Genotypic and phenotypic differences in pain between the sexes are conditioned by anatomical, physiological, neural, hormonal, psychological, and other factors, such as the response to pharmacological treatment to control pain. Women are particularly impacted by both acute and chronic pain with higher prevalence and a greater level of pain-related disability compared to men. Moreover, medications used for anesthesia or pain control are often not tailored to the woman or to the specific underlying disease. Sex-related influences on anesthesia and pain remain a topic of great interest in literature. Pain control and anesthesiological techniques remain suboptimal in many female pathologic disorders.

In this Special Issue of the Journal of Clinical Medicine, we invite you to submit your latest research papers in the form of an original article or review, on anesthesiologic management, and acute and chronic pain control techniques tailored to women.

Prof. Dr. Gaetano Draisci
Dr. Stefano Catarci
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

anesthesia
women
acute pain
chronic pain
monitoring
obstetrics
cesarean section
gynecologic surgery

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Published Papers (6 papers)

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11 pages, 614 KiB

Open AccessArticle

Fluoroscopy-Guided Transgluteal Pudendal Nerve Block for Pudendal Neuralgia: A Retrospective Case Series

by Danielle Levin, Daniel Van Florcke, Monika Schmitt, Lucinda Kurzava Kendall, Alopi Patel, Lisa V. Doan and Meera Kirpekar

J. Clin. Med. 2024, 13(9), 2636; https://doi.org/10.3390/jcm13092636 - 30 Apr 2024

Cited by 2 | Viewed by 4916

Abstract

Background/Objective: Pudendal neuralgia is a distressing condition that presents with pain in the perineum. While a positive anesthetic pudendal nerve block is one of the essential criteria for diagnosing this condition, this block can also provide a therapeutic effect for those afflicted with pudendal neuralgia. There are multiple ways in which a pudendal nerve block can be performed. The objective of this study is to share our results and follow-up of fluoroscopy-guided transgluteal pudendal nerve blocks. Methods: This is a retrospective case series. Included were 101 patients who met four out of the five Nantes criteria (pain in the anatomical territory of the pudendal nerve, pain worsened by sitting, pain that does not wake the patient up at night, and no objective sensory loss on clinical examination) who did not respond to conservative treatment and subsequently underwent a fluoroscopy-guided transgluteal pudendal nerve block. Therapeutic success was defined as a 30% or greater reduction in pain. Success rates were calculated, and the duration over which that success was sustained was recorded. Results: For achieving at least 30% relief of pain, using worst-case analysis, the success rate at two weeks was 49.4% (95% CI: 38.5%, 60.3%). In addition to pain relief, patients experienced other therapeutic benefits, such as reductions in medication use and improvements in activities of daily living. Conclusions: Fluoroscopy-guided transgluteal pudendal nerve block appears to be effective in patients who have pudendal neuralgia that is resistant to conservative therapy, with good short-term success. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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12 pages, 1064 KiB

Open AccessEditor’s ChoiceArticle

Comparison of Quality of Recovery between Modified Thoracoabdominal Nerves Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial

by Takanori Suzuka, Nobuhiro Tanaka, Yuma Kadoya, Mitsuru Ida, Masato Iwata, Naoki Ozu and Masahiko Kawaguchi

J. Clin. Med. 2024, 13(3), 712; https://doi.org/10.3390/jcm13030712 - 25 Jan 2024

Cited by 5 | Viewed by 1739

Abstract

Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) provides a wide analgesic range. Herein, we examined the quality of recovery (QoR) of M-TAPA for total laparoscopic hysterectomy (TLH) compared with oblique subcostal transversus abdominis plane block (OSTAPB) and measured plasma levobupivacaine concentrations (PC_levo). Forty female patients undergoing TLH were randomized to each group. Nerve blocks were performed bilaterally with 25 mL of 0.25% levobupivacaine administered per side. The primary outcome was changes in QoR-15 scores on postoperative days (POD) 1 and 2 from the preoperative baseline. The main secondary outcomes were PC_levo at 15, 30, 45, 60, and 120 min after performing nerve block. Group differences (M-TAPA—OSTAPB) in mean changes from baseline in QoR-15 scores on POD 1 and 2 were −11.3 (95% confidence interval (CI), −24.9 to 2.4, p = 0.104; standard deviation (SD), 22.8) and −7.0 (95% CI, −20.5 to 6.6, p = 0.307; SD, 18.7), respectively. Changes in PC_levo were similar in both groups. The post hoc analysis using Bayesian statistics revealed that posterior probabilities of M-TAPA being clinically more effective than OSTAPB were up to 22.4 and 24.4% for POD 1 and 2, respectively. In conclusion, M-TAPA may not be superior to OSTAPB for TLH. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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14 pages, 1432 KiB

Open AccessArticle

Perioperative Analgesia and Patients’ Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine

by Mihai O. Botea, Diana Lungeanu, Alina Petrica, Mircea I. Sandor, Anca C. Huniadi, Claudiu Barsac, Adina M. Marza, Ramona C. Moisa, Laura Maghiar, Raluca M. Botea, Codruta I. Macovei and Erika Bimbo-Szuhai

J. Clin. Med. 2023, 12(19), 6346; https://doi.org/10.3390/jcm12196346 - 3 Oct 2023

Cited by 12 | Viewed by 4204

Abstract

Perioperative analgesia for cesarean section aims to ensure the mother’s comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 μg) and M (morphine, standard dose 100 μg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann–Whitney U test, p < 0.001) and higher level of satisfaction (Mann–Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann–Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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12 pages, 1574 KiB

Open AccessArticle

Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study

by Martin Calineata, Lukas Jennewein, Vanessa Neef, Armin Niklas Flinspach, Frank Louwen, Kai Zacharowski and Florian Jürgen Raimann

J. Clin. Med. 2023, 12(18), 5770; https://doi.org/10.3390/jcm12185770 - 5 Sep 2023

Cited by 1 | Viewed by 1974

Abstract

Background: The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. Methods: In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. Results: The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001—II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [−5.40 vs. −6.40; p = 0.005]. Conclusions: LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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11 pages, 662 KiB

Open AccessArticle

Blended (Combined Spinal and General) vs. General Anesthesia for Abdominal Hysterectomy: A Retrospective Study

by Stefano Catarci, Bruno Antonio Zanfini, Emanuele Capone, Francesco Vassalli, Luciano Frassanito, Matteo Biancone, Mariangela Di Muro, Anna Fagotti, Francesco Fanfani, Giovanni Scambia and Gaetano Draisci

J. Clin. Med. 2023, 12(14), 4775; https://doi.org/10.3390/jcm12144775 - 19 Jul 2023

Cited by 4 | Viewed by 4051

Abstract

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. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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13 pages, 536 KiB

Open AccessProject Report

by Urszula Kosciuczuk, Agnieszka Kossakowska, Marcin Talalaj, Katarzyna Grabowska and Marta Pryzmont

J. Clin. Med. 2025, 14(7), 2163; https://doi.org/10.3390/jcm14072163 - 22 Mar 2025

Viewed by 359

Abstract

Background/Objectives: Sex is a crucial factor in modulating the perioperative aspects of anesthesia. A growing number of studies demonstrate that women and men experience pain differently and respond differentially to analgesics. Methods: This study evaluated the analgesic trajectory of low-opioid anesthesia (LOA) and opioid-based anesthesia (OBA) in women and men after laparoscopic cholecystectomy. The primary objective was to assess pain intensity at various time intervals after surgery (0–2, 2–6, 6–12, and 12–24 h) using the Numerical Rating Scale (NRS). The secondary objective was to assess the difference in mean pain intensity on the first postoperative day between the women and men. Results: The mean pain intensity did not differ significantly for men using LOA and OBA, but the value was significantly lower in the LOA group for women (p = 0.0002). The analgesic trajectory in women and men undergoing LOA presented a negative trend, but the pain intensity at 0–2, 2–6, 6–12, and 12–24 h in women was statistically lower than that of the OBA group (p = 0.01, p = 0.008, p = 0.002, and p = 0.001). Total fentanyl doses of 0.3 mg (sensitivity 44%, specificity 76%, AUC 0.55) and 0.35 mg achieved a mean NRS of <2 for pain intensity in the female and male OBA groups (sensitivity 33%, specificity 100%, AUC 0.53). Conclusions: A model combining low-opioid anesthesia and non-opioid postoperative analgesia presents a favorable therapeutic effect for women. OBA does not provide proper analgesic effects after laparoscopic cholecystectomy. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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