Bacterial meningitis after spinal and epidural anesthesia is a very rare but serious complication. We report a case of meningitis developing a number of hours after a spinal block for Caesarean section. No organism was grown but the CSF pattern was suggestive of bacterial meningitis. Severe neurological sequelae were present after three months of hospitalization. Meningitis is a serious complication and its early diagnosis and effective treatment is essential. Meningitis should always be considered as a possible differential diagnosis in patients suspected of having post spinal headache, convulsion and changes in mental statues. A thorough knowledge and practice of aseptic techniques is crucial in performing spinal and epidural anesthesia.

Background: Spinal anesthesia is a widely used technique in orthopedic and other surgical procedures due to its safety and effectiveness. Bupivacaine is the most commonly used local anesthetic, but its use alone is limited by the duration and depth of sensory and motor blockade. To enhance anesthetic quality and minimize adverse effects, adjuvants such as epinephrine and fentanyl are often added. Objectives: The objective of this study was to compare the efficacy, safety, and clinical outcomes of epinephrine versus fentanyl as intrathecal adjuvants to bupivacaine in orthopedic surgeries, focusing on motor block duration, hemodynamics, and postoperative pain control. Methods: This quasi-experimental study was conducted on 100 patients undergoing femur and tibia surgeries under spinal anesthesia at a tertiary hospital in Iran. Participants were randomized into two groups: One received intrathecal bupivacaine with epinephrine, and the other received bupivacaine with fentanyl. Outcomes compared included the duration of anesthesia, postoperative pain scores, and incidence of complications. Results: The combination of bupivacaine with epinephrine resulted in a significantly longer duration of anesthesia (222.38 ± 17.48 minutes vs. 169.88 ± 15.57 minutes; P = 0.001) and higher rates of complete muscle relaxation (84% vs. 46%; P < 0.001). However, this group showed increased incidences of hypotension (16% vs. 0%; P < 0.001) and bradycardia (10% vs. 0%; P < 0.001). The bupivacaine-fentanyl group reported lower pain scores at all time points (e.g., 1.0 ± 0.0 vs. 1.3 ± 0.73 at 30 minutes; P = 0.005) but had higher pruritus rates (14% vs. 0%; P = 0.001). Conclusions: While bupivacaine combined with epinephrine extends the duration of anesthesia, it is associated with more hemodynamic disturbances. Bupivacaine with fentanyl offers superior postoperative analgesia and a more favorable safety profile, making it a suitable option for spinal anesthesia in lower limb surgery.

Background & Objective: The use of anaesthetics has become a crucial aspect of clinical practice, particularly considering the increasing number of caesarean deliveries worldwide. The present study was conducted with aim to compare the effects of general and spinal anaesthesia on maternal and neonatal outcomes in term singleton pregnancies with elective caesarean section.Materials & Methods: This prospective and case-control study was conducted on 100 patients randomly allocated into two equal groups: general anaesthesia (n=50) and spinal anaesthesia (n=50). Hemodynamic variables of the mother were measured preoperatively, intraoperatively, and postoperatively, and neonatal outcome was assessed by the Apgar score.Results: In the general anaesthesia group, systolic and diastolic blood pressure showed only mild reductions after induction and during delivery, with values stabilising postoperatively. Meanwhile, heart rate transiently increased after induction before returning to baseline. In contrast, the spinal anaesthesia group demonstrated a more pronounced hypotensive response, with systolic and diastolic pressures reaching their lowest levels at delivery, followed by gradual postoperative recovery; heart rate also declined steadily after induction. The mean time between anaesthesia induction and baby extraction was 7.2±1.5 minutes, well within the safe range (5-10 minutes), supporting favourable maternal and neonatal outcomes. The median one-minute Apgar score was higher in the spinal anaesthesia group.Conclusion: In elective caesarean, maternal and neonatal outcomes are better with spinal anaesthesia. Nonetheless, both methods are still heavily used, dependent and clinically indicating dependent

Background: The term "outpatient surgery" has become a common procedure in most hospitals around the world. On other hand, Spinal aesthesia can mimic the outcome sought by the principle of outpatient surgeries since it takes a short time to recover and limits the need for post-operative pain medication Therefore, the objective of this study is to focus on finding a method to reduce the side effects that commonly accompany the procedure of spinal aesthesia and to avoid the possible hemodynamic changes that may occur. Methods: The method for the study will be a narrative review of various medical journals, conferences papers, and unpublished documents using the dual keywords, outpatient surgeries spinal aesthesia, and ambulatory aesthesia, we include in this research thirty-one original articles, fifty-three reviews articles, two books, three handbooks, and two guidelines searched in the deferent database (google scholar, Research gate, pub med, science direct). Results: Consideration should be given to the quality of patients who participate in outpatient concepts. Finally, in terms of cost, side effects, and patient satisfaction, the spinal aesthetic approach gives a favourable outcome since it covers post-operative time without the need for analgesia and reduces the percentage of postoperative nausea and vomiting, and reduces the time staying in the hospital. Conclusions: In conclusion, the study discovered that a major proportion of surgeries performed over our lifetimes are outpatient procedures. Therefore, Discharge criteria should be posed with one precise criterion. There is no standard protocol to serve these types of surgeries and patients. The only criteria found and practiced served general conditions for outpatients and inpatients. There have been several attempts to create a protocol that can meet the pleasing outcome of outpatient surgeries. Consequently, we need more research to cover this lack and serve the Genuine needs of a protocol to define the criteria and categories that concern the term outpatient and outpatient surgeries and lead to improving the quality of outpatient surgeries with fewer side effects and minimum hemodynamic changes.