A decade of global health partnership to advance obstetric anesthesia practices in the Balkans: a retrospective analysis of neuraxial anesthesia and analgesia use at a major teaching hospital in Serbia (2012-2025).

BACKGROUND: Neuraxial anesthesia use for cesarean delivery and neuraxial labor analgesia in the Balkans is low due to previous regional conflict and long-standing traditions. In 2012, Serbian anesthesiologists at the University Clinical Center of Vojvodina initiated collaboration with Kybele, Inc. to improve obstetric anesthesia practices. A unique training experience was offered to anesthesiologists from Serbia and surrounding countries, facilitated by international experts. This study describes the intervention and changes in neuraxial anesthesia use from 2012 to 2025. METHODS: A one to two week hands-on and didactic obstetric anesthesia school was conducted annually or biannually from 2012 to 2025; in-person activities were interrupted from 2020 to 2022. Training included spinal, epidural and combined-spinal epidural techniques for cesarean delivery and labor analgesia, and truncal nerve blocks for postoperative pain control. Participant demographics and longitudinal trends in neuraxial anesthesia use for cesarean delivery and neuraxial labor analgesia were collected. RESULTS: 130 anesthesiologists from 41 hospitals across five countries attended the hands-on school; 36.2% participated multiple times. At University Clinical Center of Vojvodina, neuraxial anesthesia use for cesarean delivery increased from 13.8% in 2011 to 79.9% in 2025 (4.7% average annual rate of change; t value = 3.24; P = 0.006). Labor analgesia use increased from 2.0% to 14.1% (P < 0.001). CONCLUSION: A longitudinal global health partnership supported obstetric anesthesia education and local training capacity. During this period, use of neuraxial anesthesia for cesarean delivery and neuraxial labor analgesia increased at University Clinical Center of Vojvodina.