{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T10:59:57Z","timestamp":1761649197132,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 &gt; 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 \u00b1 18 mcg in Group 3 vs. Group 1 31.8 \u00b1 16.2 mcg, Group 2 44.1 \u00b1 15.6, p &lt; 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 &lt; 0.001). Intraoperative hypotension (MAP &lt; 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 &lt; 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 \u00b1 44 min, Group 2 91.9 \u00b1 46.5 min, Group 3 126 \u00b1 90.7 min, p &lt; 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\u2019s physical status and the type of surgery, preventing and treating side effects of pain treatments.<\/jats:p>","DOI":"10.3390\/jcm12144775","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T21:21:46Z","timestamp":1689801706000},"page":"4775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Blended (Combined Spinal and General) vs. General Anesthesia for Abdominal Hysterectomy: A Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-6527","authenticated-orcid":false,"given":"Stefano","family":"Catarci","sequence":"first","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1312-5382","authenticated-orcid":false,"given":"Bruno Antonio","family":"Zanfini","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2241-3839","authenticated-orcid":false,"given":"Emanuele","family":"Capone","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-9427","authenticated-orcid":false,"given":"Francesco","family":"Vassalli","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Perinatal Medicine, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-2591","authenticated-orcid":false,"given":"Luciano","family":"Frassanito","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Biancone","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariangela","family":"Di Muro","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Fagotti","sequence":"additional","affiliation":[{"name":"Department of Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Fanfani","sequence":"additional","affiliation":[{"name":"Department of Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Scambia","sequence":"additional","affiliation":[{"name":"Department of Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Draisci","sequence":"additional","affiliation":[{"name":"Department of Scienze Dell\u2019Emergenza, Anestesiologiche e Della Rianimazione, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/ACO.0b013e328330373a","article-title":"Multimodal analgesia for controlling acute postoperative pain","volume":"22","author":"Buvanendran","year":"2009","journal-title":"Curr. Opin. 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Scand."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4775\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:14:44Z","timestamp":1760127284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":26,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12144775"],"URL":"https:\/\/doi.org\/10.3390\/jcm12144775","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}