Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Ultrasound vessel sizing before cannulation: a measurement-first approach for anesthesiologists.","authors":"Luis Alberto Rodriguez Linares, Sarah Cerillo Lopes","doi":"10.1186/s44158-026-00399-3","DOIUrl":"10.1186/s44158-026-00399-3","url":null,"abstract":"<p><p>The catheter gauge and length are often chosen based on visual estimation. Ultrasound allows for the direct measurement of vessel diameter and depth, which may reduce failed attempts, particularly in patients with difficult access and pediatric patients. This narrative review evaluated trials, meta-analyses, and guidelines on ultrasound-guided vascular access in adults and children to derive practical sizing rules for venous and arterial cannulation in anesthesiology. Key recommendations include targeting a catheter-to-vein ratio (CVR) ≤ 0.45 for peripheral IVs and using long catheters for deeper veins (≥ 8-10 mm); limiting catheter size to ≤ 1/3 of the vessel's luminal area (outer diameter/inner diameter ratio ≤ 0.577) for arterial lines to prevent spasm. A pediatric reference table links typical radial artery diameters to appropriate 22-24G catheter choices. Selecting central venous catheters that occupy approximately ≤ 33% of the vein's diameter may be a reasonable strategy to minimize complications. Evidence from clinical trials supports US-guided peripheral IV and radial artery cannulation over landmark-based techniques. We propose a five-step workflow (scan, measure, select gauge/length, US-guided cannulation, and confirmation) to implement this measurement-first approach. In conclusion, an ultrasound measurement-first strategy aligns catheter selection with vessel dimensions, improving first-pass success and reducing complications in both adult and pediatric practices. The proposed sizing tables and algorithm are intended to serve as practical decision-support tools for bedside applications.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984645","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":"Reply to commentary on \"The influence of thirty-degree leg elevation on noradrenaline requirements administered as a prophylactic variable infusion during cesarean delivery, an open-label randomized controlled trial.\"","authors":"Mina Adolf Helmy, Lydia Magdy Milad","doi":"10.1186/s44158-026-00413-8","DOIUrl":"10.1186/s44158-026-00413-8","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977599","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":"Effect of positive end-expiratory pressure levels on splanchnic perfusion and intra-abdominal pressure: a prospective clinical-experimental study in lung-healthy patients.","authors":"L O Harnisch, D Tampe, J Wieditz, O Moerer","doi":"10.1186/s44158-026-00411-w","DOIUrl":"10.1186/s44158-026-00411-w","url":null,"abstract":"<p><strong>Background: </strong>High levels of airway pressure and especially positive end-expiratory pressure (PEEP) have been reported to reduce splanchnic perfusion and consequently lead to organ damage. We evaluated the effect of increasing PEEP levels on splanchnic perfusion and intra-abdominal pressure in a prospective clinical-experimental trial.</p><p><strong>Methods: </strong>In 20 neurosurgical patients, who were admitted to ICU due to the risk of postoperative complications, we measured the renal and splenic Doppler resistance index (RRI and SRI), intra-abdominal pressure (IAP), and the venous impedance index (VII) at different levels of PEEP (5 to 15 cmH₂O) using a non-invasive ultrasound technique.</p><p><strong>Results: </strong>Twenty patients were included in the final analysis. All RRI and SRI values remained within the reference range throughout the protocol, with low measurement variability (SD: RRI 0.06; SRI 0.09; VII 0.22). As PEEP levels increased from 5 to 15 cmH₂O, peak and plateau pressures rose significantly, while driving pressure remained constant. Differences between PEEP levels were not significant for IAP (η²G = 0.011, p = 0.298), RRI (η²G = 0.034, p = 0.253), SRI (η²G = 0.008, p = 0.719), or VII (η²G = 0.015, p = 0.070). No significant correlations with PEEP were found for RRI (r =-0.179, p = 0.081) or SRI (r = -0.130, p = 0.205). Mean arterial pressure was stable (84 ± 11 mmHg) and did not correlate with RRI (r = 0.195, p = 0.106), but correlated with SRI (r = 0.250, p = 0.037) and IAP (r = 0.275, p = 0.022). Exploratory mixed-effects models suggested a modest effect of PEEP on RRI (-0.002, p = 0.036) and a significant effect on VII (-0.007, p = 0.003), though patient-specific factors dominated the variance (R²c = 0.60-0.91).</p><p><strong>Conclusion: </strong>In our cohort of mechanically ventilated, hemodynamically stable, non-fluid-responsive, healthy patients, we found no effect of increasing PEEP levels on intra-abdominal pressure or surrogates of splanchnic perfusion, but an increase in renal venous drainage at higher PEEP levels; these findings warrant confirmation in larger samples.</p><p><strong>Trial registration: </strong>The study was registered in the German clinical trials register (DRKS-ID: DRKS00023895 on 15.02.2021).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977681","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":"Post-spinal cesarean hypotension.","authors":"Maria Piscopo, Marco Cascella, Ornella Piazza","doi":"10.1186/s44158-026-00410-x","DOIUrl":"10.1186/s44158-026-00410-x","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977596","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":"The interplay of circadian rhythms and cancer pain: a narrative review.","authors":"Daniele Marelli, Andrea Sbrana, Nicola Sbalzer, Cosimo Chelazzi","doi":"10.1186/s44158-026-00407-6","DOIUrl":"10.1186/s44158-026-00407-6","url":null,"abstract":"<p><strong>Background: </strong>Cancer-associated pain affects the majority of patients with advanced disease, involves complex nociceptive, neuropathic, and psychosocial mechanisms, and remains inadequately controlled despite available pharmacological options. Circadian rhythms regulate sleep-wake patterns, hormone secretion, immune function, and nociceptive signaling. Their disruption, common in cancer patients due to disease burden, treatment side effects, and psychological distress, may influence both pain perception and analgesic response. This narrative review examines the interplay between chronobiology and cancer-associated pain, evaluating the biological plausibility and clinical readiness of chronotherapy, the role of non-pharmacological circadian-supportive interventions, and the exploratory contribution of medical cannabis within this framework.</p><p><strong>Discussion: </strong>Circadian patterns in cancer pain and breakthrough cancer pain are inconsistent at the population level, with discrepancies between clinical reports of late-morning peaks and experimental evidence of nocturnal pain sensitivity, suggesting that observed patterns are largely driven by pharmacokinetic, activity-related, and tumor-specific factors. Opioid pharmacokinetics and pharmacodynamics are influenced by circadian variation, and aligning dosing with individual pain and metabolic patterns may theoretically enhance analgesic efficacy, though prospective evidence remains limited. Opioid therapy itself disrupts circadian organization, reinforcing the value of strategies that simultaneously time drug administration and support circadian stability. Non-pharmacological interventions including sleep hygiene, light therapy, structured exercise, and psychological approaches carry established safety profiles and consistent benefits on quality of life, though their direct analgesic contribution within a chronotherapy framework remains to be established. The endocannabinoid system exhibits circadian rhythmicity, but robust trial data supporting medical cannabis for cancer pain and sleep regulation are absent, and current guidelines maintain a cautious stance. The identification of objective circadian biomarkers is a critical prerequisite before chronotherapy can be evaluated in phase III trials.</p><p><strong>Conclusion: </strong>Circadian biology offers a biologically plausible but insufficiently validated framework for optimizing cancer pain management. Clinicians can already incorporate sleep hygiene measures, morning light exposure, and structured physical activity into existing cancer pain management plans while awaiting higher-level evidence. Future research must prioritize biomarker validation, large-scale RCTs of timed opioid administration, and implementation science to translate chronotherapy from hypothesis to guideline-level practice.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950509","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":"Perioperative anemia and patient blood management in neurosurgery and neurocritical care: a narrative review.","authors":"Rudin Domi, Sarah Saxena, Joana Berger-Estilita, Daniele Guerino Biasucci, Basak Ceyda Meco, Krenar Lilaj, Gentian Huti, Idit Matot, Francesca Rubulotta, Anne-Marie Camilleri-Podesta","doi":"10.1186/s44158-026-00406-7","DOIUrl":"10.1186/s44158-026-00406-7","url":null,"abstract":"<p><p>Correction of anemia in the perioperative period is essential to reduce complications, optimise tissue oxygen delivery and improve overall patient outcomes. However, in neurosurgical and neurocritical care settings, the management of preoperative anemia presents unique challenges. The brain is highly sensitive to reductions in oxygen delivery, whereas interventions commonly used to correct anemia, most notably blood transfusions, carry inherent risks that may adversely affect neurological outcomes. Therefore, clinicians must carefully balance the prevention of cerebral hypoxia to avoid treatment-related complications.The prevalence of perioperative anemia in neurosurgical and neurocritical patients is influenced by multiple factors, including advanced age, comorbidities, frailty, malnutrition, chronic anticoagulant or antiplatelet therapy and the type and extent of planned intervention.Patient blood management provides a structured, multimodal approach for optimising oxygen delivery, while reducing exposure to allogeneic blood transfusion. Within this framework, anemia correction represents only one pillar, alongside strategies to minimise perioperative blood loss and enhance physiological tolerance to anemia. In neurosurgical and neurocritical care, patient blood management may include targeted anemia treatment (e.g. iron supplementation, erythropoiesis-stimulating agents or carefully restricted transfusion), management of coagulation disturbances using specific \"antidotes\" such as tranexamic acid and close monitoring of cerebral oxygenation to individualize transfusion and hemodynamic decisions.Despite the limited standardization of patient blood management pathways in neurosurgery, current evidence suggests that it represents a coherent and physiologically grounded approach that may contribute to improved outcomes in this high-risk patient population.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935609","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":"Indications, therapeutic modalities and clinical outcomes of hyperbaric oxygen therapy in Italy, the ITA-OTI Study: a multicentre prospective observational study.","authors":"Mariachiara Ippolito, Luca Martani, Alberto Noto, Laura Maniscalco, Giulia Spurio, Marina Nasello, Salvatore Sardo, Vincenzo Francesco Tripodi, Savino Borraccino, Luigi Giancarlo Vicari Sottosanti, Carlotta Ferraro, Luca Cantadori, Andrea Neville Cracchiolo, Luigi Targa, Fiorenzo Fracasso, Andrea Giovaniello, Fiammetta Ronga, Claudio Spena, Elena Giovanna Bignami, Domenica Matranga, Antonino Giarratano, Andrea Cortegiani","doi":"10.1186/s44158-026-00403-w","DOIUrl":"10.1186/s44158-026-00403-w","url":null,"abstract":"<p><strong>Background: </strong>Real-world data describing contemporary hyperbaric oxygen therapy (HBOT) practice in Italy are limited. This study aimed to describe current clinical indications and therapeutic modalities of HBOT at the national level.</p><p><strong>Methods: </strong>We conducted a multicentre, prospective, observational national study, promoted by Italian Society of Anesthesia Analgesia, Resuscitation and Intensive Care (SIAARTI). We included consecutive patients who underwent HBOT in 10 study centres within a period of 12 weeks, for any treatment indication. The primary outcome of the study was the proportion of treatments by clinical indication and urgency of treatment.</p><p><strong>Results: </strong>Overall, 327 patients were included across 10 centres, of which 73.7% (n = 241) received elective and 26.3% (n = 86) urgent treatments. The most frequent indication was sudden hearing loss (35.8%), followed by carbon monoxide poisoning (19.9%) and soft tissue infection (12.2%). Treatments were delivered at a median of 2.5 ATA, with two oxygen cycles for session and a median of 16 sessions for patients. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>In Italy, HBOT is applied in accordance with national and international guidelines. The most frequent indications to treatment were sudden hearing loss, carbon monoxide poisoning, and soft tissue infections. Treatments had similar characteristics across the centres, with heterogeneity mainly regarding the number of sessions per patient.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936103","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":"Impact of extracorporeal circuits on systemic drug levels - a scoping review.","authors":"Rajib Paul, Abdul Ansari, David Ballesteros, Harriet Adamson, Teresa Klaus, Patrick M Honoré","doi":"10.1186/s44158-026-00404-9","DOIUrl":"10.1186/s44158-026-00404-9","url":null,"abstract":"<p><strong>Background: </strong>This scoping review explores the potential effects of various extracorporeal technologies on the clearance of commonly used drugs. Understanding these interactions is essential for ensuring patient safety and treatment effectiveness.</p><p><strong>Methods and results: </strong>A comprehensive search was performed including the PubMed, Cochrane and clinicaltrials.gov databases, with additional searches of relevant reference lists. Specific keywords relating to drug removal, therapeutic drug monitoring, and individual extracorporeal circuit platforms were used including drug removal/drug elimination/drug levels AND Continuous Renal Replacement Therapy (CRRT) or Extracorporeal Membrane Oxygenation (ECMO) or Therapeutic Plasma Exchange (TPE) or Molecular Adsorbent Recirculating Systems (MARS) or CytoSorb. CytoSorb was chosen as the representative hemoadsorption platform due to it having by far the most publications on this topic. In total 2231 articles were found with 300 included in the final review. Ten articles clearly reported removal by more than one platform so were included twice. The impact on drug levels was discussed for 157 different drugs with several publications including more than one drug. Most evidence was found for CytoSorb (158 publications/72 drugs) followed by ECMO (112 publications/55 drugs). The majority of data came from single case reports (126 articles), and case series (100 articles) with 68% (203) reporting on unwanted removal of therapeutic drugs.</p><p><strong>Conclusion: </strong>The potential for drug removal by various extracorporeal therapies in critical care is an important topic worthy of serious consideration. Available evidence to support informed decision making is limited and further research to advance the current evidence base is urgently needed. Therapeutic drug monitoring remains recommended to support clinical decision-making to enhance patient safety when using such technologies.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876784","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":"Which fascial plane block is right for my patient? A practical decision-making algorithm for abdominal surgery.","authors":"Ellile Sultan, Matthew A Kosasih, Amit Pawa, Barbara Versyck, Edward R Mariano","doi":"10.1186/s44158-026-00400-z","DOIUrl":"10.1186/s44158-026-00400-z","url":null,"abstract":"<p><strong>Background: </strong>Optimizing postoperative pain management is central to successful recovery following abdominal surgery and is a key component of enhanced recovery protocols. While multimodal analgesia is considered standard practice, selecting the most appropriate regional analgesic technique remains challenging, especially when neuraxial analgesia is contraindicated or undesirable. Ultrasound-guided abdominal fascial plane blocks have emerged as valuable alternatives, offering targeted somatic analgesia with favorable safety profiles. However, the growing number of available techniques has created uncertainty regarding optimal block selection for specific abdominal surgeries.</p><p><strong>Clinical decision tool: </strong>Our clinical decision tool aims to complement existing guidelines regarding fascial plane blocks with a simple algorithm to help the general anesthesiologist choose an appropriate fascial plane block for specific abdominal surgeries. We have also considered real-world factors such as ultrasound availability and institutional support for continuous catheters. Within this review, we discuss the current evidence and technical performance for the following procedures: transversus abdominis plane block, rectus sheath block, external oblique intercostal plane block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum block. Consistent with the Plan A blocks framework, this decision-making algorithm applies updated nomenclature and consideration of practical factors that influence choice of block by the general anesthesiologist when performing regional analgesia at the point of care.</p><p><strong>Conclusion: </strong>Abdominal fascial plane blocks are versatile and low-risk additions to a multimodal analgesic regimen for abdominal surgery. Our structured, site-specific, decision-making framework can assist physicians in selecting the most appropriate fascial plane block for abdominal surgery while accounting for patient, surgical, and institutional factors. Such an approach supports individualized analgesic planning and may enhance postoperative recovery, particularly when neuraxial techniques are unsuitable or unavailable.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870573","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":"Dystocia and analgesia: which came first? Time of choice of neuraxial labor analgesia and obstetric outcomes: a community-based retrospective cohort study.","authors":"Enrica Delfino, Emanuele Koumantakis, Christine Rollandin, Milena Maule, Lorena Charrier, Alessandra Consales, Elena Boris, Roberto Giorgio Wetzl, Luca Montagnani, Livio Leo, Maria Lorella Giannì","doi":"10.1186/s44158-026-00394-8","DOIUrl":"10.1186/s44158-026-00394-8","url":null,"abstract":"<p><strong>Background: </strong>Neuraxial labor analgesia (NLA) has long been considered a risk factor for cesarean and vacuum delivery. We aim to investigate if, as suggested in the literature, these adverse outcomes are rather associated with a dystocic painful labor prompting an NLA request.</p><p><strong>Methods: </strong>This community-based cohort study was conducted from January 2010 to March 2023 in a Baby Friendly Hospital which supports physiological childbirth. Nulliparous women who received NLA (n = 1905) were divided into 2 groups according to whether they chose to request NLA a priori (before experiencing labor pain; AP group, n = 395) or in labor (after experiencing labor pain; IL group, n = 1510). A descriptive analysis of the sample was performed. The primary outcome was mode of delivery. A multinomial logistic regression model was used to assess in-labor request as a possible predictor of vacuum extraction and cesarean delivery, considering maternal age, height, and BMI as confounders.</p><p><strong>Results: </strong>Groups differed in median maternal age (31 vs 30 years AP vs IL, respectively P < 0.001) and neonatal weight (3195 vs 3270, P < 0.007). The risk of cesarean delivery was higher in the IL group (RRR 2.35; 95% CI 1.70 to 3.23; P < 0.001), while that of vacuum extraction was comparable between the two groups (RRR 0.81; 95% CI 0.53 to 1.21; P = 0.293).</p><p><strong>Conclusions: </strong>The higher incidence of cesarean delivery in the IL group compared to the AP group suggests that many women asking for NLA in labor have underlying risk factors for cesarean delivery: the relationship between NLA and cesarean delivery might not be causal. The association with vacuum remains less clear.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876825","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}