Abstract: Objectives: An effective and harmless analgesic method for postoperative pain management in abdominal surgery remains undefined. Although intrathecal morphine(ITM) and four-quadrant transversus abdominis plane blocks(four-quadrant TAPB) are frequently preferred for postoperative analgesia, their effectiveness is still controversial. The aim of this study was to evaluate the efficacy of 4 quadrant TAPB with ITM in postoperative analgesia in gynaecological cancer surgeries. Methods: In this study, we retrospectively compared the effectiveness of intrathecal morphine and four-quadrant transversus abdominis plane blocks for postoperative analgesia in patients undergoing clossed or open major gynecologic cancer surgery. Results: We retrospectively evaluated a total of 65 patients operated on for gynecologic cancer. In terms of perioperative analgesic methods, 46% of these patients received ITM and 54% received four-quadrant TAPB. Demographic data, American Society of Anaesthesiology (ASA) clinical classification, operation time and length of hospital stay were similar. Postoperative 1- and 24-hour numeric rating scale (NRS) scores and opioid consumption were lower in the ITM group (p< 0.05). When the patient population was evaluated laparotomically and laparoscopically, it was found that the postoperative 1- and 24-hour NRS values, postoperative 24-hour opioid consumption levels and opioid demand levels in laparoscopic cases were lower in the ITM group (p< 0.05). Postoperative adverse effects and complications were similar in both groups. Conclusion: It was found that in gynecologic cancer surgery, intrathecal morphine was more effective in postoperative pain management and reduced the need for postoperative opioids compared to four-quadrant transversus abdominis plane blocks.

Abstract: Maxillofacial trauma constitutes one of the significant public health issues globally owing to its multifactorial etiology, ramifications, and socioeconomic burden on the world of health care. This article systematically reviews maxillofacial injury epidemiology, prevention, economic effect, and complications. The cause of such injuries is varied with road traffic accidents, inter-personal violence, and occupational hazards being major contributors globally. In particular, prevention strategies, road safety, violence prevention, occupational safety regulations, are useful in the reduction of incidence and severity of such injuries. But implementing these measures has been challenging — especially in low- and middle-income countries where the disparities in health care are reflected in the outcomes. The financial burden is not limited to direct medical expenses, as it includes loss of productivity, ongoing rehabilitation, and psychotherapy. This review also discusses new trends in surgical management, novel technologies such as 3D printing, and the need for international collaboration to address differences in care delivery. Notably, the comprehensive nature of maxillofacial trauma identified in the present study points to an opportunity to enhance preventability, mitigate impact and ultimately alleviate global burden.

Abstract: Introduction - Critical care medicine is a complex activity where knowledge, experience, intuition, and sometimes even luck converge. Diagnosing diseases and selecting effective therapies represent a daily challenges for clinicians, requiring them to analyze and process vast amounts of information. Patient’s medical history, clinical signs and symptoms, laboratory results, and radiological findings are just some of the elements that must be considered during routine practice. At times, the sheer volume of data can overwhelm doctors, exposing them to the risk of becoming lost in a maze of irrelevant information. This narrative review focuses on a curated set of biomarkers renowned for their reliability in supporting clinical decision-making. By leveraging these tools, we aim to streamline decision-making processes and enhance patient outcomes in the ICU’s high-stakes environment.

Abstract: Background: The emergency room is a fast-paced, high-pressure environment that de-mands efficient, streamlined medical procedures. Preoperative femoral nerve blocks re-main underutilized and less discussed compared to traditional intravenous opioid ad-ministration. This study evaluates the analgesic efficacy of femoral nerve blocks and in-vestigates whether they can reduce opioid use, thereby decreasing the workload for emer-gency healthcare professionals. Methods: Patients with femoral fractures presenting to the emergency room were enrolled. A single emergency physician administered femoral nerve blocks in the treatment group (Group 1). The primary outcome was the improvement in pain scores measured by the numerical rating scale (NRS), while the secondary outcome was the frequency of intravenous opioid administration. These outcomes were compared with a standard care group receiving only intravenous opioids (Group 2). Results: Group 1 exhibited a greater reduction in NRS pain scores, with an average decrease of 4.96 com-pared to 3.99 in Group 2. Although the difference in opioid administration frequency ap-proached significance (1.35 in Group 1 vs. 1.64 in Group 2, p = 0.063), the trend favors re-duced opioid use in Group 1. Additionally, the mean time to an extra opioid administra-tion after the nerve block was 6.49 hours. Conclusions: Femoral nerve blocks provide su-perior analgesia for femoral fractures and may lower the reliance on intravenous opioids, potentially reducing the burden on emergency staff. Further research is warranted to con-firm these findings and assess the impact on opioid administration frequency.

Abstract: Post-Acute Sequelae of COVID (PASC), commonly known as Long COVID, presents with a broad spectrum of medical conditions and symptoms persisting beyond three months post-SARS-CoV-2 infection, affecting over 18 million Americans and 65 million people worldwide. Despite its prevalence, to date, there are no specific clinical guidelines for the perioperative management of PASC patients. PASC is a complex, multisystemic condition leading to neurological, respiratory and endocrine sequelae, potentially resulting from persistent viral presence, immune dysregulation, and/or end-organ damage. This manuscript discusses the implications of these sequelae on anesthesia practice, emphasizing the need for vigilance in pre-operative assessments to identify PASC and associated conditions through detailed patient history, understanding of off-label medication use, and familiarity with medical terminologies like POTS, MCAS and brain fog. Key perioperative considerations include cautious use of anesthetics, especially in patients with neurological and cardiovascular complications. Pulmonary management strategies for PASC patients, such as lung-protective ventilation and non-invasive post-operative support could mitigate any perioperative respiratory complications. Finally, we underscore the importance of a multidisciplinary approach to manage PASC patients effectively during surgery, advocating for personalized anesthetic plans and calling for more evidence driven guidelines for this emerging patient group as research progresses.

Abstract: Background: Spinal anesthesia is considered the method of choice for elective cesarean sections; however, it is not without maternal-fetal risks. Materials and Methods: This study compared the effects on maternal hemodynamics of intrathecal administration of fentanyl (F) or morphine (M) in pregnant women undergoing spinal anesthesia with 0.5% hyperbaric bupivacaine, with doses varied between 7.5 mg - 11 mg, depending on the patient's height. Data from a cohort of 170 pregnant women were analyzed. The administered doses were intrathecal M at 0.1 mL (100 µg, solution of 1 mg/mL) or F at 0.25 mL (25 µg, solution of 50 µg/mL). The study included 80 patients in group F and 90 in group M. Results: The group F showed significantly higher post-intervention systolic blood pressure values than the group M (95.30 ± 12.99 mmHg vs. 90.58 ± 14.75 mmHg, p = 0.032). The incidence of vomiting was significantly less frequent in group F compared to group M (1, 1.3% vs. 10, 11.1%, p = 0.011). The total dose of ephedrine required for hypotension correction was significantly lower in the F group (12.75 ± 13.26 mg vs. 17.72 ± 16.73 mg, p = 0.035). Conclusions: The addition of F as an adjuvant alongside the local anesthetic in cesarean section is associated with better hemodynamic stability compared to M, requiring lower doses of ephedrine, and thus increasing patient safety during elective cesarean surgery.

Abstract: Background and Objectives: We have conducted a retrospective study on patients who underwent total hip arthroplasty. We analyzed spinal anesthesia hemodynamic effects for optimal spinal anesthesia-induced hypotension (SAIH) management. This study explored the perioperative factors related to spinal anesthesia-induced hypotension and the dose of Ephedrine used to ensure hemodynamic stability. Materials and methods: Every patient benefits from information regarding details of the surgery approach and possible intraoperative hemodynamic variations induced by spinal anesthesia (SA). Three hundred twenty-nine patients were included in this study. We compared two groups based on the type of SA: bupivacaine with morphine (group M) and bupivacaine with fentanyl (group F). Results: We observed that the amount of ephedrine dose used correlates with high blood pressure (HBP) in 19 % of cases and with age in 44,1%. Conclusion: Ephedrine use for hemodynamic stability is the key to ensuring safer and more effective perioperative care.

Abstract: Objective: Neurogenic thoracic outlet syndrome (nTOS) is a rare compression neuropathy and establishing a firm diagnosis can be challenging. Interscalene nerve blocks with Ropivacaine and Dexamethasone have been proposed in cases with typical symptoms and without evident pathology of the thoracic outlet (i.e. disputed nTOS) to establish the diagnosis. The aim of this study was to evaluate the effectiveness of interscalene nerve block for long term pain relief in patients with true and disputed nTOS. Methods: Patients between 18 and 90 years of age with either true or disputed nTOS were prospectively included into the study. All patients received an interscalene nerve block with Ropivacaine and Dexamethasone. At baseline, 2, 6, 12, and 24 weeks after infiltration, minimum and maximum pain levels were assessed using the numeric rating scale (NRS 0-10). Furthermore, arm function was assessed using the Quick-DASH and health-related quality of life was assessed by means of the SF-12 questionnaire. Statistical analysis was done with SPSS version 29.0 using the Wilcoxon signed rank test and t-test for paired samples. A p-value below 0.05 was considered as statistically significant. Results: 21 patients were included into the study. There was a significant decrease of the minimum (pmin) and maximum (pmax) mean pain levels 2 and 6 weeks after baseline. Thereafter, 12 patients dropped out of the study due to surgery. In the remaining 9 patients, pain levels remained significantly lower than baseline at 12 and 24 weeks after infiltration. Quick-DASH scores as well as the physical domain of the SF-12 showed significant improvement compared to baseline. Conclusion: In patients with true and disputed nTOS, long term pain relief can be achieved with the interscalene nerve block with Ropivacaine and Dexamethasone. Additionally, the study indicated an improvement in arm function and health-related quality of life. In patients with disputed nTOS, the interscalene nerve block may be a useful tool to establish the diagnosis of clinically relevant true nTOS.

Abstract: Chronic widespread pain (CWP) is characterized by persistent pain across multiple body regions, often accompanied by fatigue, cognitive difficulties, and psychological distress. Background/Objectives: Affecting approximately 10% of the general population, CWP disproportionately impacts women, individuals from lower socioeconomic backgrounds, immigrants, and those with a family history of chronic pain. Standard treatments, including cognitive-behavioral therapy, exercise, and pharmacotherapy, often provide insufficient relief. This study explores a novel approach to treating treatment-resistant CWP: high-dose subcutaneous lidocaine infusions administered over extended periods. Methods: The research included a retrospective chart review and patient survey to evaluate safety and tolerability. The protocol started with a dose of 10-12 mg/kg of adjusted body weight, increasing by 10-15% per month, with a maximum dose of 2000 mg. Results: The chart review of 27 patients revealed mild to moderate side effects in seven patients, with no severe adverse events. A survey of 15 patients indicated a higher incidence of side effects; however, all patients reported that the benefits outweighed the negatives. On average, patients experienced 61% pain relief, lasting 19 days per infusion. Conclusions: This study demonstrates that subcutaneous lidocaine infusions are a well-tolerated treatment for CWP, offering significant pain relief and improving patients' quality of life.

Abstract: Background and aims: Prostatectomy is a common surgical procedure for prostate cancer, the most frequently diagnosed cancer in the male population. The choice of anaesthetic technique has a significant impact on postoperative pain management. The changes in recommendations between 2015 and 2021 prompted this study to evaluate the impact of intrathecal morphine administration in combination with general anaesthesia compared to general anaesthesia alone on postoperative analgesic consumption and associated side effects. Material and Methods: A single center retrospective cohort study was conducted, analysing data from 202 patients who underwent prostatectomy between 2015 and 2021. Patients were divided into two groups: 147 patients received intrathecal morphine combined with general anaesthesia, while 49 patients received general anaesthesia alone. Key postoperative parameters, including Numerical Rating Scale (NRS) scores, analgesic consumption, and side effects (e.g., nausea, pruritus, hypotension, respiratory depres-sion) were evaluated. Statistical analyses were performed using Mann-Whitney U-tests and multiple regression models. Results: The group receiving intrathecal morphine showed a significant decrease in NRS pain scores at rest and during movement (p < 0.001). The need for postoperative analgesics, especially opioids such as piritramide, was reduced in this group. No significant increase in serious side effects such as respiratory depression was observed. Conclusion: The present study investigates the potential of intrathecal morphine combined with general anaesthesia as a promising approach to improve pain management in prostatectomy patients. By reducing pain intensity, this method shows significant clinical benefits. In addition, the absence of a significant increase in serious adverse events reinforces the safety of this approach. However, further studies are warranted to assess long-term outcomes and explore optimal dosing strategies. The re-introduction of this anaesthetic technique has great potential to improve patient recovery and satisfaction following major surgery.

Abstract:

Opioid analgesics have been used for more than 5,000 years and remain the main pain medications prescribed today. Although morphine is considered the gold standard of pain relief, this selective µ-opioid receptor (MOP) agonist provides only moderate relief for many chronic pain conditions, and produces a number of unwanted effects that can affect the patient’s quality-of-life, prevent adherence to treatment or lead to addiction. In addition to the lack of progress in developing better analgesics, there have been no significant breakthroughs to date in combating the above-mentioned side effects. Fortunately, a better understanding of opioid pharmacology has given renewed hope for the development of better and safer pain medications. In this review, we describe how clinically approved opioids were initially characterized as biased ligands and what impact this approach might have on clinical practice. We also looked at the preclinical and clinical development of biased MOP agonists, focusing on the history of oliceridine, the first specifically designed biased analgesic. In addition, we explore the discrepancies between ligands with low intrinsic efficacy and those with biased properties. Finally, we examine the rationale behind the development of biased ligands during the opioid crisis.

Abstract: Background and Objectives: Quadratus lumborum block (QLB) is a regional anesthesia technique widely utilized in multimodal analgesia strategies for abdominal surgeries. While a few studies have investigated its efficacy in multiport total laparoscopic hysterectomy (TLH), its effectiveness in single-port TLH remains uncertain. This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH. Materials and Methods: This randomized, controlled, observer-blinded trial included 64 patients undergoing elective single-port TLH. Participants were randomly allocated to either the QLB group (n = 27) or the control group (n = 29). QLB was performed bilaterally under ultrasound guidance after surgery. The primary outcome was cumulative fentanyl consumption within 24 hours postoperatively. Secondary outcomes included pain scores at predefined intervals, time to first opioid demand, the incidence of postoperative nausea and vomiting (PONV) and other complications. Results: The 24-hour cumulative fentanyl consumption, which was the primary outcome, did not differ significantly between the QLB group 470 [191.6, 648.1] mcg and the control group 342.8 [220, 651] mcg (P = 0.714). Additionally, cumulative fentanyl consumption at other time points, including 2h, 4h, 8h, 12h, 32h, and 48h, as well as in the PACU, also showed no significant differences between the two groups. Pain scores measured at these time points, along with the time to first bolus on demand, similarly showed no significant differences between the groups. Conclusions: QLB did not significantly reduce opioid consumption or pain scores in patients undergoing single-port TLH.

Abstract: This research explores the creation of an AI-driven model to improve anesthesia dosage precision, particularly for pediatric patients. Children present unique challenges in anesthesia due to their developing organs and varying metabolism. Traditional methods often rely on generalized guidelines and clinician expertise, which may not adequately address individual variability, especially in pediatrics. To overcome these limitations, this study employs advanced machine learning (ML) techniques, including supervised learning and ensemble methods, to develop predictive models tailored to each patient’s characteristics.

Abstract: Biomedical sciences have made immense progress and numerous discoveries aimed at improving quality of life and life expectancy in modern times. Anesthesiology is typically tailored to individual patients as its clinical effects depend on multiple factors, including a patient’s physiological and pathological states, age, environmental exposures and genetic variations. Sex differences are also paramount for a complete understanding of the effects of specific anesthetic medications on men and women. However, women-specific research and the inclusion of women in clinical trials, specifically during child-bearing years, remain disproportionately low compared to the general population at large. This review describes and summarizes genetic variations, including sex differences, that affect responses to common anesthetic medications such as volatile anesthetics, induction agents, neuromuscular blocking drugs, opioids and local anesthetics. It also discusses the influence of genetic variations on anesthesia outcomes such as post-operative nausea and vomiting, allergic reactions, pain, depth of anesthesia, awareness under anesthesia and recall, and post-operative delirium.

Abstract: Introduction: Optimal control of acute postoperative pain in major surgery accelerates the recovery process, shortens hospital stays, and minimizes healthcare costs. Intrathecal morphine is a simple, safe, and reliable regional technique that provides prolonged analgesia, useful in a wide variety of procedures. Materials and Methods: A retrospective observational study was conducted on patients who underwent various major abdominal or thoracic surgical procedures and were administered intrathecal morphine between January 2018 and December 2021. The primary objective was to establish the safety of the technique in terms of the incidence of early and late respiratory depression, atelectasis, the need for respiratory support, and the possible association of these complications with the presence of respiratory pathology such as chronic obstructive pulmonary disease (COPD) or sleep apnea-hypopnea syndrome (SAHS), and obesity or smoking habit. Secondary objectives included recording the consumption of rescue intravenous (IV) morphine in the first 24 hours postoperatively, the incidence of PONV, and the incidence of late postoperative complications (at 90 days) such as pneumonia, readmission rates, and reoperation rates. Hospital stay and mortality were also recorded. Results: A total of 484 patients were included in the study. No patient experienced respiratory depression. Atelectasis, evidenced by chest X-ray, occurred in 2.07% of patients. Respiratory support with non-invasive mechanical ventilation (NIMV) or high-flow oxygen therapy (HFOT) was required by 1.86% of patients. 51% of patients required rescue IV morphine (average 6.98 mg), significantly higher in the thoracic and general surgery groups compared to urological surgery. The incidence of postoperative nausea and vomiting (PONV) was 30.37%. Regarding other secondary objectives, readmissions, reoperations, and mortality rates were significantly higher in patients undergoing urological and thoracic surgery compared to those undergoing general surgery. Conclusion: The administration of intrathecal morphine for the control of acute postoperative pain in major surgery can be considered a safe technique that fits perfectly within the set of measures for the multimodal approach to pain management in major abdominal and thoracic surgery.

Abstract: Background: The characteristics of hemodynamic coherence in healthy states and disease remain unknown. Capillary tortuosity is a morphologic variant of microcirculatory vessels but its effects have generally not been considered in the assessment of tissue perfusion and oxygenation. We investigated the role of sublingual capillary tortuosity in the hemodynamic coherence of anesthetized individuals with steady-state physiology and patients with septic shock. Methods: Sublingual macro- and microcirculatory variables, oxygen transport, metabolic parameters and the capillary tortuosity score (CTS) were assessed. Results: Mean (SD) CTS was 0.55 (0.76) and 3.31 (0.86) in the steady-state and septic shock group, respectively (p < 0.001). In patients with septic shock, CTS was significantly associated with Alveolar-to-arterial oxygen gradient (r = 0.658, p = 0.015) and oxygen debt (r = –0.769, p = 0.002). Significant differences were also observed in Consensus Proportion of Perfused Vessels (PPV; p < 0.001), Consensus PPV (small) (p < 0.001), Microvascular Flow Index (p < 0.001), vessel diameter (p < 0.001) and length (p < 0.001), wall shear stress (p < 0.001), lactate (p < 0.001), oxygen extraction ratio (p = 0.001), arterial oxygen content (p < 0.001), venous oxygen content (p < 0.001), oxygen delivery (p < 0.001), oxygen consumption (p < 0.001), and oxygen debt (p = 0.002) between the two groups. Conclusion: Sublingual tortuosity was essentially absent in individuals with steady-state physiology. In contrast, it was significantly increased and associated with Alveolar-to-arterial oxygen gradient and oxygen debt in critically ill patients with septic shock.

Abstract:

Background/Objectives: To assess the feasibility and effectiveness of a perioperative opioid-sparing anesthesia-analgesia (OSA-A) technique without regional nerve blocks compared to standard opi-oid-based technique (OBA-A) in open thoracotomies. Methods: This retrospective, propensi-ty-matched, case-control study was conducted at a university hospital from January 2017 to Feb-ruary 2021, including adult patients undergoing open thoracotomy for lung or pleura pathology. Sixty patients in the OSA-A group were matched with 40 in the OBA-A group. Outcomes included postoperative pain scores on days 0, 1, and 2; 24-hour postoperative morphine consumption; PACU and hospital length of stay; time to bowel movement; and rates of nausea and vomiting. Results: Of 120 eligible patients, 100 had complete records (60 OSA-A, 40 OBA-A). Demographics were similar, but ASA status scores were higher in the OBA-A group. The OSA-A group reported significantly lower pain levels at rest, during cough, and on movement on the first two postoperative days, shorter PACU stay, and required fewer opioids. They also had better gastrointestinal motility (p<0.0001) and lower rates of nausea and vomiting on postoperative days 1 and 2. A follow-up study with 68 patients (46 OSA-A, 22 OBA-A) assessing chronic pain prevalence found no signif-icant differences between the groups. Conclusions: OSA-A without regional nerve blocks for open thoracotomies is feasible and safe, improving postoperative pain management, reducing opioid consumption, shortening PACU stay, and enhancing early gastrointestinal recovery compared to OBA-A.

Abstract: Background/Objectives: Unanticipated difficult airways remain a significant challenge in anesthesia practice and are associated with increased severe complication risk. This study developed and validated a novel predictive tool for identifying unanticipated difficult airways. Methods: This retrospective case-control study analyzed data from 62,111 patients who underwent general anesthesia between 2015 and 2020. Among them, 98 unanticipated difficult airways were identified and matched in a 1:3 ratio with 294 controls. Multivariate logistic regression was utilized to determine key predictors for developing the CLAIR score, which integrates coagulopathy, hypocalcemia, laryngoscopic view, potential airway difficulty, and the presence of inexperienced residents. Results: The incidence of unanticipated difficult airways was 0.16%. The CLAIR score exhibited excellent discriminative performance, with an area under the receiver operating characteristic curve of 0.93. At an optimal cutoff of 4, the score achieved a sensitivity of 86% and a specificity of 90%. Patients were stratified into high (≥6), intermediate (1–5), and low (≤0) risk categories, facilitating tailored airway management strategies. A web-based risk calculator, accessible via a QR code, further enhances its utility in real-time clinical applications. Conclusions: Implementing the CLAIR score holds significant promise for enhancing preoperative risk assessment, optimizing resource allocation, and improving patient safety in diverse anesthesia settings. Future prospective studies and robust external validation are essential to establishing the generalizability of the CLAIR score and confirming its efficacy in reducing airway-related complications. This novel tool represents a paradigm shift in airway management, addressing a longstanding challenge in anesthesia practice with a practical and actionable solution.

Abstract:

Perioperative neurocognitive disorders (PNDs), including postoperative delirium, delayed neurocognitive recovery, and long-term postoperative neurocognitive disorders, present significant challenges for older patients undergoing surgery. Inflammation is a protective mechanism triggered in response to external pathogens or cellular damage. Historically, the central nervous system (CNS) was considered immunoprivileged due to the presence of the blood–brain barrier (BBB), which serves as a physical barrier preventing systemic inflammatory changes from influencing the CNS. However, aseptic surgical trauma is now recognized to induce localized inflammation at the surgical site, further exacerbated by the release of peripheral pro-inflammatory cytokines, which can compromise BBB integrity. This breakdown of the BBB facilitates the activation of microglia, initiating a cascade of neuroinflammatory responses that may contribute to the onset of PNDs. This review explores the mechanisms underlying neuroinflammation, with a particular focus on the pivotal role of cytokines in the pathogenesis of PND.

Abstract:

Epidural analgesia is widely regarded as the gold standard for pain relief during labor. Despite its effectiveness, significant disparities in adoption persist due to cultural, medical, and informational factors. This study aimed to analyze online search behaviors related to epidural analgesia in the six most populous European countries, evaluate temporal trends, and assess the predictive power of machine learning models for search volumes.MethodsWeekly search data from 2020 to 2024 were obtained from Google Trends for France, Germany, Italy, Spain, Turkey, and the United Kingdom (UK). Data were analyzed using linear regression, time-series decomposition, and Mann-Kendall tests to identify monotonic trends. An Auto Regressive Integrated Moving Average (ARIMA) model was developed to forecast search volumes for 2025. Machine learning models such as Random Forest (RF) and Gradient Boosting Machine (GBM), were employed to evaluate the influence of variables such as country and temporal factors on search patterns. Model performance was assessed using specific metric (R², RMSE, MAE, and MBE) and statistical comparisons were made between the models.ResultsFrance and Turkey exhibited significant downward trends in search interest, while Germany showed a slight upward trend, and Italy, Spain, and the UK demonstrated stable patterns. ARIMA forecast indicated stable search volumes for most countries, with the UK reaching the highest activity. RF outperformed GBM, achieving R² values of 0.92 (testing) and 0.93 (training), with "Country" identified as the most influential predictor. Associated queries highlighted common public concerns, including epidural timing, risks, and side effects.ConclusionsThese findings reveal the value of understanding public interest in epidural analgesia to address concerns effectively. Healthcare providers should guide patients toward reliable online information. Future initiatives should include educational tools, national health programs, and interdisciplinary collaboration to enhance informed decision-making and optimize maternal care outcomes.