Local and Regional Anesthesia最新文献

{"title":"Multimodal Spinal Anesthesia in Somalia: Evidence, Implementation Considerations, and a Safety Framework for Resource-Limited Settings - A Narrative Review.","authors":"Hodo Aideed Asowe, Samira Abdullahi Mo'alim, Mohamed Hussein Adam, Ahmed Mahad Sheikh Mohamed, Mohamed Adam Mahamud, Bashiru Garba, Jamal Hassan Mohamoud","doi":"10.2147/LRA.S627136","DOIUrl":"10.2147/LRA.S627136","url":null,"abstract":"<p><strong>Background: </strong>Safe anesthesia remains difficult to deliver in many resource-limited settings because of shortages of trained providers, monitoring equipment, oxygen, essential medicines, recovery facilities, and critical-care support. Spinal anesthesia is widely used for cesarean delivery and selected lower abdominal, urologic, perineal, and lower-limb procedures. Its contemporary use extends beyond the intrathecal injection to include patient selection, dose planning, hemodynamic management, multimodal analgesia, monitoring, postoperative observation, and rescue readiness.</p><p><strong>Objective: </strong>This narrative review examines the available evidence, implementation considerations, and minimum safety requirements for multimodal spinal anesthesia in Somalia and comparable resource-limited settings.</p><p><strong>Methods: </strong>A structured narrative literature search was conducted using PubMed/MEDLINE, Google Scholar, ScienceDirect, Cochrane-related sources, WHO and WFSA resources, and relevant global surgery literature. Sources addressing spinal or neuraxial anesthesia, obstetric anesthesia, multimodal analgesia, anesthesia safety, low-resource surgery, and Somalia's anesthesia and critical-care context were considered. Evidence was synthesized thematically and categorized as published clinical evidence, international safety standards, contextual interpretation, or proposed implementation recommendations.</p><p><strong>Findings: </strong>Spinal anesthesia may reduce dependence on some components of general anesthesia infrastructure for appropriately selected patients, but it is not inherently safe. Minimum requirements include a trained provider, patient assessment, blood-pressure and oxygen-saturation monitoring, intravenous access, oxygen, vasopressors, airway rescue equipment, postoperative observation, and protocols for hypotension, failed block, high spinal block, and conversion to general anesthesia. Cesarean delivery represents an important area for standardization. Intrathecal adjuvants should be selected according to each facility's monitoring and recovery capacity.</p><p><strong>Conclusion: </strong>Somalia-specific evidence on spinal anesthesia outcomes remains limited. The proposed framework should therefore be considered evidence-informed rather than locally validated. Prospective local audits are needed before claims regarding effectiveness, affordability, or improved outcomes can be made.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"627136"},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Low-Dose Morphine Intrathecal Analgesia in Elderly Patients with Hip Fracture Undergoing Single Spinal Anesthesia: A Randomized Controlled Trial\" [Response to Letter].","authors":"Denis Buršík","doi":"10.2147/LRA.S644718","DOIUrl":"10.2147/LRA.S644718","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"644718"},"PeriodicalIF":1.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lidocaine Delivery Systems for Preventing Postoperative Sore Throat: From Direct Spray to Soft Mist.","authors":"Yuan Xie, Yaxiong Gao","doi":"10.2147/LRA.S627037","DOIUrl":"https://doi.org/10.2147/LRA.S627037","url":null,"abstract":"<p><p>Postoperative sore throat (POST) is common after tracheal intubation, with pooled estimates of 32.4% at 1 hour and 16.4% at 24 hours in a recent systematic review. This narrative review examines how lidocaine delivery systems influence airway deposition, tolerability, duration of exposure, and safety. PubMed/MEDLINE and Crossref-indexed records were searched from inception through July 20, 2026, with backward citation tracking. Randomized trials, systematic reviews, pharmacology studies, and device or aerosol studies relevant to POST prevention or airway topicalization were prioritized. Direct spray is rapid, familiar, and inexpensive but produces operator-dependent deposition and may provoke coughing. Nebulization is gentler and useful for awake airway management, although delivered dose and anatomic coverage vary with the device and breathing pattern. Alkalinized intracuff lidocaine provides sustained exposure at the cuff-tracheal interface; in one 90-patient trial, POST occurred in 13% versus 67% of placebo recipients at 24 hours. Soft-mist delivery may reduce plume-related irritation, but its evidence base remains preliminary: a single-center 100-patient trial reported 24-hour POST in 4% versus 38% of controls, without comparison against optimized spray or nebulization. These estimates should not be compared as treatment rankings because populations and protocols differed. Lidocaine is best used selectively within a multimodal bundle that includes appropriate endotracheal-tube sizing, atraumatic intubation, cuff-pressure control, cumulative-dose accounting, and standardized outcome assessment. No delivery system has yet been shown to be definitively superior or most cost-effective.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"627037"},"PeriodicalIF":1.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Interscalene Brachial Plexus Block: Single Bolus Injection versus Continuous Catheter Placement in Arthroscopic Rotator Cuff Repair with Implications for Postoperative Rehabilitation - A Prospective Randomized Unblinded Trial.","authors":"Renata Beck, Pietro Palumbo, Antonella Cotoia, Giuseppe Maccagnano, Domenico Merlicco, Angelo A Carrideo, Lucia Distaso, Mario Pedone, Emanuele Pio Ricci, Michela Rauseo, Lada Zibar, Gilda Cinnella","doi":"10.2147/LRA.S595813","DOIUrl":"10.2147/LRA.S595813","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the effectiveness of the interscalene brachial plexus single-shot block (ISBSS) versus continuous block (ISBC) in managing acute and chronic postsurgical pain (PSP) in patients undergoing upper extremity surgery, and differences between the two groups in rehabilitation.</p><p><strong>Patients and methods: </strong>Patients who underwent shoulder arthroscopy under locoregional anesthesia received either single-shot (ISBSS group) (n = 42) or continuous perineural catheter (ISBC group) anesthesia (n = 38). The primary outcome was the numeric rating scale (NRS) score related to PSP evaluation. Secondary outcomes included the American Shoulder and Elbow Surgeons Score (ASES), range of motion (ROM) in degrees, hospital length of stay, and opioid consumption, all measured postoperatively and during the rehabilitation evaluation.</p><p><strong>Results: </strong>ISBC group exhibited lower median [interquartile range, IQR] NRS score than ISBSS group at postoperative hour 20 (2 [2 to 3] vs 4 [2 to 5]), 24 (2 [2 to 2] vs 4 [1 to 5]), 48 (1 [1 to 2] vs 4 [4 to 5]), 72 (1.5 [1 to 2] vs 5 [4 to 5]) (<i>P</i> < 0.001, resp.); at postoperative day 7 (1 [1 to 2] vs 5 [5 to 6], <i>P</i> < 0.001) and postoperative month 1 (1 [1 to 1] vs 3 [3 to 3], <i>P</i> < 0.001). The ISBC group demonstrated lower opioid consumption, a better ASES score, and higher ROM grades at follow-up month 3 for flexion, abduction, and internal and external rotation (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Continuous interscalene brachial plexus catheter infusion may effectively control acute and chronic PSP, facilitating better rehabilitation and healing than single shot injection.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"595813"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Low-Dose Morphine Intrathecal Analgesia in Elderly Patients with Hip Fracture Undergoing Single Spinal Anesthesia: A Randomized Controlled Trial\" [Letter].","authors":"Wenjuan Qiao, Jie Meng","doi":"10.2147/LRA.S638823","DOIUrl":"10.2147/LRA.S638823","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"638823"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Thoracoabdominal Nerve Block Through the Perichondrial Approach versus Thoracic Epidural Analgesia for Postoperative Analgesia in Robot-Assisted Colorectal Surgery: A Retrospective Cohort Study.","authors":"Tatsuya Yamamoto, Yukiko Yoshida, Yoko Ochiai, Masao Hayashi, Katsuhisa Kawaguchi, Masaaki Michida, Mizuho Matsushima, Hiroshi Katayama, Ichiro Ohashi","doi":"10.2147/LRA.S608149","DOIUrl":"10.2147/LRA.S608149","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic epidural analgesia is widely considered the gold standard for postoperative pain management in abdominal surgery; however, it is associated with workflow limitations and potential hemodynamic instability. The modified thoracoabdominal nerve block through the perichondrial approach (m-TAPA) has emerged as an alternative technique for abdominal wall analgesia. This study aimed to compare the analgesic efficacy and perioperative impact of epidural analgesia and m-TAPA in patients undergoing robot-assisted colorectal surgery.</p><p><strong>Patients and methods: </strong>This retrospective, single-center, non-randomized cohort study included 45 adult patients who underwent robot-assisted laparoscopic colorectal resection between January and October 2024. Patients received either thoracic epidural analgesia (n = 23) or bilateral single-shot m-TAPA (n = 22), selected at the discretion of the attending anesthesiologist. The primary outcome was postoperative pain intensity assessed using the Numerical Rating Scale (NRS) at 4-hour intervals. Secondary outcomes included intraoperative and postoperative opioid consumption, time from operating room entry to surgical incision, vasopressor use, and analgesia-related complications.</p><p><strong>Results: </strong>Postoperative NRS scores were comparable between groups up to 16 hours after surgery. At 20 and 24 hours postoperatively, pain scores were significantly lower in the epidural group. Intraoperative and postoperative fentanyl consumption was significantly higher in the m-TAPA group (p < 0.01 for both comparisons). The time from operating room entry to surgical incision was significantly shorter in the m-TAPA group (p = 0.035). Postoperative bolus vasopressor therapy was more frequently required in the epidural group (p = 0.0045). The incidence of postoperative nausea and vomiting, atelectasis, neurological complications, urinary retention, and intensive care unit length of stay did not differ significantly between groups.</p><p><strong>Conclusion: </strong>In this small retrospective cohort, m-TAPA provided comparable early postoperative analgesia but was associated with higher opioid consumption compared with epidural analgesia. Given the non-randomized design, small sample size, and differences in analgesic duration between techniques, these findings should be interpreted with caution. m-TAPA may represent a practical alternative in selected patients; however, further prospective studies are required to confirm these findings.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"608149"},"PeriodicalIF":1.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Search of Ideal Analgesia: Classical and Deep Rectus Sheath Block in Laparoscopic Cholecystectomy.","authors":"Serge Chooklin, Serhii Chuklin","doi":"10.2147/LRA.S610083","DOIUrl":"10.2147/LRA.S610083","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy (LC) is the gold standard of treatment for symptomatic cholelithiasis. Despite its minimally invasive nature, LC is still associated with moderate postoperative pain that may delay early mobilization, oral intake, and discharge while increasing the need for opioids. Within ERAS protocols, multimodal analgesia using regional techniques has become increasingly important. The rectus sheath block (RSB) is considered a useful option for controlling the somatic pain component related to the periumbilical port site.</p><p><strong>Materials and methods: </strong>A narrative literature review was conducted using PubMed, Scopus, and Google Scholar to identify studies published up to 2026. The analyses included prospective randomized and non-randomized studies, retrospective case series, anatomical investigations, and expert recommendations. In addition to the classical RSB, the deep rectus sheath block (DRSB) was evaluated as a potentially relevant technique for addressing not only somatic but also peritoneum-related pain.</p><p><strong>Results: </strong>Classical RSB, performed by injecting local anesthetic between the rectus abdominis muscle and the posterior rectus sheath, provides effective analgesia in the periumbilical port area, reduces postoperative pain intensity, and decreases opioid consumption during the first 24 h after LC compared with wound infiltration or systemic analgesia alone. DRSB, which targets the preperitoneal plane between the posterior rectus sheath and parietal peritoneum, has shown promising analgesic effects in isolated clinical reports after LC and epigastric hernia repair, with possible benefits for peritoneum-related pain. However, the current evidence for DRSB remains limited to case reports and small case series, and its exact mechanism of action is still debated.</p><p><strong>Conclusion: </strong>RSB is a valuable component of multimodal analgesia for LC, with a demonstrated opioid-sparing effect and favorable safety profile under ultrasound guidance. DRSB appears promising, but remains experimental. Further well-designed randomized trials are needed to define its indications, optimal technique, and role in standardized analgesic protocols for LC.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"610083"},"PeriodicalIF":1.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Delirium Following Continuous Fascia Iliaca Compartment Block in Elderly Patients with Hip Fracture: A Case Series and Literature Review.","authors":"Lei Cao, Guoqiang Xu, Zhenyu Liu, Xiaodong Bai, Li Li, Hua Gao","doi":"10.2147/LRA.S609445","DOIUrl":"10.2147/LRA.S609445","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication in elderly patients with hip fracture. This study aimed to investigate the occurrence of POD in patients receiving continuous fascia iliaca compartment block (CFICB) with an opioid-containing solution, and review current evidence.</p><p><strong>Case presentation: </strong>We retrospectively analyzed four elderly patients (aged 73-90 years) who developed delirium after receiving opioid-containing CFICB for hip fracture surgery. All received ultrasound-guided CFICB with ropivacaine 0.25% (loading dose 40mL) followed by continuous infusion (sufentanil 50μg + ropivacaine 100mg in 240mL saline at 3mL/h). The Montreal Cognitive Assessment (MoCA) was administered on admission. Patient characteristics were: Case 1 (73-year-old female, delirium onset postoperative day 4, MoCA = 26); Case 2 (90-year-old male, delirium onset postoperative day 2, MoCA = 18, surgery delayed 6 days); Case 3 (75-year-old male, delirium onset within 24 hours of surgery, MoCA = 28); Case 4 (87-year-old female, delirium occurred on the day of the block placement, MoCA = 15). Despite excellent post-CFICB pain control Visual Analog Scale (resting VAS ≤ 3) in all patients, delirium occurred, with durations ranging from 36 hours to 120 hours.</p><p><strong>Conclusion: </strong>This small case series (n = 4) suggests that opioid-containing CFICB provides effective perioperative analgesia for elderly hip fracture patients but does not completely prevent postoperative delirium, particularly in patients with advanced age, baseline cognitive dysfunction, or delayed surgery. Given the retrospective design and small sample size, these findings are exploratory only. Larger prospective studies are needed.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"609445"},"PeriodicalIF":1.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mode of Anesthesia During Cesarean Section and Neonatal Morbidity and Mortality: A Cohort Study.","authors":"Ala A Alhowary, Omar Altal, Wasim Khasawneh, Saif Aldin Naif Rawabdeh, Rania Al-Bataineh, Anas Alrusan, Tareq Khaldoon Bashaireh, Lana Haddad, Rola Madain, Ahmed H Al Sharie","doi":"10.2147/LRA.S582928","DOIUrl":"10.2147/LRA.S582928","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"582928"},"PeriodicalIF":1.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Morphine Intrathecal Analgesia in Elderly Patients with Hip Fracture Undergoing Single Spinal Anesthesia: A Randomized Controlled Trial.","authors":"Denis Buršík, Tereza Romanová, Karolína Lečbychová, Markéta Bílená, Michal Burda, Pavel Ševčík, Filip Haiduk, Michal Frelich, Marcela Káňová, Jan Máca","doi":"10.2147/LRA.S598583","DOIUrl":"10.2147/LRA.S598583","url":null,"abstract":"<p><strong>Background: </strong>Hip 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.</p><p><strong>Methods: </strong>Patients 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.</p><p><strong>Results: </strong>This 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 (<i>p</i> < 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 (<i>p</i> < 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 (<i>p</i> = 0.001). The incidence and severity of adverse effects did not significantly differ between the groups.</p><p><strong>Conclusion: </strong>Compared 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.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"598583"},"PeriodicalIF":1.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}