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Opioid-Sparing and Multimodal Analgesia in Cesarean Delivery: A Systematic Review of Evidence and Implementation Across High and Low-Middle Income Countries: A Systematic Review Agastya, Wayan Dhea; Rahmadinie, Amalia
Journal of Diverse Medical Research : Medicosphere Vol. 2 No. 9 (2025): J Divers Med Res 2025
Publisher : Faculty of Medicine - Universitas Pembangunan Nasional Veteran Jawa Timur

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33005/jdiversemedres.v2i9.214

Abstract

ABSTRACT Introduction: Cesarean delivery is a common surgical procedure worldwide, often accompanied by significant postoperative pain that can negatively impact recovery, early breastfeeding, and maternal mobility. Opioids have traditionally been central to post-cesarean analgesia but are associated with side effects such as nausea, vomiting, pruritus, sedation, and respiratory depression. Recently, opioid-sparing and multimodal analgesia strategies—combining neuraxial opioids, regional blocks (e.g., transversus abdominis plane [TAP] block), and non-opioid systemic agents (NSAIDs, acetaminophen)—have been increasingly adopted to reduce opioid consumption while maintaining effective analgesia. Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published from January 2021 to August 2025. Eligible studies included randomized controlled trials, cohort studies, and quality improvement projects evaluating opioid-sparing multimodal analgesia in women undergoing cesarean delivery in both high-income countries (HICs) and low- and middle-income countries (LMICs). Primary outcomes were postoperative opioid consumption and pain scores; secondary outcomes included opioid-related side effects, recovery milestones, maternal satisfaction, and neonatal safety. Data extraction and quality assessment were performed independently by two reviewers following PRISMA 2020 guidelines. Discussion: The review included nine studies from diverse settings. Multimodal analgesia regimens consistently reduced opioid consumption and pain scores, improved maternal satisfaction, and decreased opioid-related adverse effects. Regional techniques such as TAP block were effective adjuncts or alternatives to neuraxial opioids, especially in LMICs where opioid availability and monitoring are limited. Adoption of multimodal protocols was more widespread in HICs, often integrated within enhanced recovery after cesarean (ERAC) pathways. Barriers in LMICs included limited regional anesthesia expertise, drug availability, cost, and institutional protocols, highlighting the need for capacity building and context-specific guidelines. Conclusion: Opioid-sparing multimodal analgesia is effective, safe, and feasible across various healthcare settings, improving postoperative pain control and recovery after cesarean delivery. Addressing implementation gaps between HICs and LMICs through training, resource allocation, and simplified protocols is essential to optimize global obstetric analgesia. Future research should focus on standardizing regimens, evaluating long-term maternal and neonatal outcomes, and overcoming implementation challenges to facilitate broader adoption.
The Effectiveness of Health Promotion on the Prevention of Urolithiasis: Narrative Literature Review Yogi Bisma Widawasista; Irma Seliana; Wayan Dhea Agastya
Jurnal Kesehatan dan Kedokteran Vol. 5 No. 1 (2026): Februari: Jurnal Kesehatan dan Kedokteran
Publisher : Asosiasi Dosen Muda Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56127/jukeke.v5i1.2389

Abstract

Urolithiasis remains a significant public health problem due to its high recurrence rate and strong association with lifestyle-related risk factors, such as inadequate hydration and unhealthy dietary habits. Preventive efforts through health promotion are therefore essential, not only to reduce recurrence but also to support broader public health goals, including the achievement of Sustainable Development Goal (SDG) 3. Objective: This study aimed to review the effectiveness of health promotion interventions in preventing urolithiasis between 2020 and 2025 and to examine their contribution to achieving SDG 3. Method: This study employed a narrative literature review design using secondary data from articles published between 2020 and 2025. The literature was retrieved from Google Scholar, GARUDA, and university journal portals. Selected studies were analysed descriptively and thematically to identify the types of health promotion interventions and their reported outcomes in urolithiasis prevention. Findings: The review showed that health promotion interventions were effective in improving knowledge, attitudes, and preventive behaviours related to urolithiasis. Community-based and school-based programs increased awareness of adequate hydration, healthy dietary patterns, and water-consumption habits, demonstrating their positive contribution to prevention efforts. Implications: These findings suggest that health promotion is a practical and cost-effective strategy for preventing urolithiasis and may also support broader non-communicable disease prevention initiatives aligned with SDG 3. The integration of digital health approaches is recommended to strengthen program sustainability and encourage long-term behavioural change. Originality: This review provides a focused synthesis of post-2020 evidence on preventive health promotion strategies for urolithiasis. Its value lies in extending the discussion beyond clinical management by offering context-specific insights that contribute to public health practice and preventive health policy.
A Narrative Review Hospital Disaster Management as a Strategic Component of the National Emergency Response System: A Narrative Review Wayan Dhea Agastya; Amalia Rahmadinie; Ayesha Jasmine Firdausi
Journal of Diverse Medical Research : Medicosphere Vol. 3 No. 3 (2026): Journal of Diverse Medical Research : Medicosphere 2026
Publisher : Faculty of Medicine - Universitas Pembangunan Nasional Veteran Jawa Timur

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33005/jdiversemedres.v3i3.307

Abstract

Hospitals constitute a critical pillar of national emergency response systems, particularly in disaster-prone regions. Beyond their clinical function, hospitals act as coordination hubs for medical response, triage, logistics, and intersectoral collaboration. This narrative review critically examines the strategic role of hospitals in disaster management across preparedness, mitigation, response, and recovery phases. Evidence from international guidelines, peer-reviewed studies, and Indonesian experiences indicates that structured hospital disaster management significantly improves operational resilience, continuity of essential services, and patient outcomes. Strengthening hospital disaster preparedness through standardized planning, regular simulations, and incident command systems is essential for enhancing health system resilience and reducing disaster-related morbidity and mortality.