Background:
The timing of anaesthesia administration may influence both drug efficacy and
postoperative recovery, and understanding these temporal variations is
essential for optimising anaesthetic management and patient outcomes. In
particular, circadian physiology modulates cardiovascular stress responses,
immune function, hormonal secretion, and the pharmacokinetics and
pharmacodynamics of anaesthetic agents, as well as pain perception, making time
of day a potentially important determinant of perioperative outcomes. However,
evidence on circadian effects in neuraxial anaesthesia for cesarean delivery
remains limited, particularly regarding inflammatory and stress markers,
highlighting the need to determine whether anaesthesia administration time
affects block characteristics, postoperative pain, and biomarkers such as CRP
and cortisol.
Aim: To
assess how spinal anaesthesia timing affects block duration, postoperative
pain, and CRP and cortisol levels in cesarean deliveries.
Methods:
Ninety women were divided into three groups based on spinal anaesthesia timing:
Group A (08:00–16:00), Group B (16:00–00:00), and Group C (00:00–08:00). Standardised spinal
anaesthesia was administered. Sensory/motor blockade and pain (NRS) were
assessed every 10 minutes. Blood samples for CRP and cortisol were collected
preoperatively and at 2, 4, 24, and 48 hours postoperatively.
Results:
Group C showed shorter sensory and motor blockade than Groups A and B
(p<0.05). Time to first analgesic request was longest in Group A, while
Group C reported the highest pain scores (p<0.05). CRP levels were
significantly higher in Group B vs. Group A at 24 and 48 hours, and vs. Group C
at 48 hours (p<0.05). Group B demonstrated the steepest CRP velocity,
indicating a more rapid physiological stress response. BMI differences may have
influenced biomarker dynamics.
Conclusion:
Cesarean sections performed under spinal anaesthesia during the early daytime
were associated with prolonged sensory and motor block, lower postoperative
pain scores, and a more favourable CRP profile compared with procedures later
in the day. In contrast, late‑afternoon and nighttime anaesthesia
were linked to shorter block duration, higher pain scores, and increased
inflammatory responses, with the most pronounced CRP increase observed in the
late‑afternoon group. Distinct BMI–CRP correlation patterns across time groups
further indicated that both the timing of spinal anaesthesia and patient
characteristics shape the perioperative inflammatory profile. These findings
indicate that time of day is a clinically relevant, modifiable factor in
neuraxial anaesthesia for cesarean delivery and suggest that scheduling spinal
anaesthesia in earlier daytime windows may optimise block quality,
postoperative analgesia, and inflammatory response.
Author(s) Details
Evangelia Nikouli
Department of
Anaesthesiology, General Hospital of Komotini, Thrace, Greece.
Nikoleta Koutlaki
Department of
Obstetrics and Gynaecology, Faculty of Medicine, Democritus University of
Thrace, Greece.
Kostas Anagnostopoulos
Laboratory of
Biochemistry, Faculty of Medicine, Democritus University of Thrace, Greece.
Soultania Anna Toubalidou
Faculty of Social,
Political and Economic Sciences-Democritus University of Trace, Komotini,
Thrace, Greece.
Christina Tsigalou
Laboratory of
Hygiene and Environmental Protection, Department of Medicine, Democritus
University of Thrace, Greece.
Pelagia Chloropoulou
Department of
Anesthesiology, Alexandroupolis University Hospital, Democritus University of
Thrace, 68100 Alexandroupolis, Greece.
Please see
the book here :- https://doi.org/10.9734/bpi/msup/v5/6992
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