Hodo Aideed Asowe,1,2 Samira Abdullahi Mo’alim,3 Mohamed Hussein Adam,2,4 Ahmed Mahad Sheikh Mohamed,2,4 Mohamed Adam Mahamud,2,3 Bashiru Garba,2,4 Jamal Hassan Mohamoud2,41Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Banaadir, Somalia; 2SIMAD Institute for Global Health (SIGHt), SIMAD University, Mogadishu, Banaadir, Somalia; 3Department of Medical Laboratory, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Banaadir, Somalia; 4Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Banaadir, SomaliaCorrespondence: Hodo Aideed Asowe, Email hodotani@simad.edu.soBackground: 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.Objective: This narrative review examines the available evidence, implementation considerations, and minimum safety requirements for multimodal spinal anesthesia in Somalia and comparable resource-limited settings.Methods: 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.Findings: 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.Conclusion: 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.Keywords: spinal anesthesia, neuraxial anesthesia, Somalia, low-resource settings, cesarean delivery, anesthesia safety, multimodal analgesia
Denis Buršík1–31Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic; 2Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 3Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno, Czech RepublicCorrespondence: Denis Buršík, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic, Email denis.bursik@fno.cz
Yuan Xie,1 Yaxiong Gao21Department of Anesthesiology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, 730000, People’s Republic of China; 2Department of Acupuncture and Tuina, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, People’s Republic of ChinaCorrespondence: Yaxiong Gao, Department of Acupuncture and Tuina, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, People’s Republic of China, Email Gao202508@foxmail.comAbstract: 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.Keywords: postoperative sore throat, topical anesthesia, lidocaine, drug delivery, nebulization, endotracheal tube cuff, soft-mist device
Purpose: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. Patients and Methods: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. Results: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]) (P < 0.001, resp.); at postoperative day 7 (1 [1 to 2] vs 5 [5 to 6], P < 0.001) and postoperative month 1 (1 [1 to 1] vs 3 [3 to 3], P < 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 (P < 0.001). Conclusion:Continuous interscalene brachial plexus catheter infusion may effectively control acute and chronic PSP, facilitating better rehabilitation and healing than single shot injection.
Wenjuan Qiao, Jie MengDepartment of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of ChinaCorrespondence: Jie Meng, Department of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China, Tel +86 17709871989, Email mandjie@163.com
