1
|
Ferguson JE, Tubog TD, Johnson W, Evans H, Furstein J. Quadratus Lumborum Block and Transversus Abdominis Plane Block in Non-emergency Cesarean Delivery: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024; 39:226-234. [PMID: 37865903 DOI: 10.1016/j.jopan.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE Investigate the analgesic efficacy of quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block in postoperative pain management in nonemergent cesarean section. DESIGN Systematic review with meta-analysis. METHODS PubMed, Cochrane, CINAHL, Google Scholar, and gray literature were searched for evidence. Only randomized controlled trials examining the effects of QL and TAP block for nonemergent cesarean delivery were included. Mean difference (MD) was used to estimate continuous outcomes with appropriate effect models. The quality of evidence was rated using the Risk of Bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. FINDINGS Six studies involving 543 parturients were included. Compared to the TAP block, the cumulative 24-hour pain score at rest (MD, -0.60; 95% CI, -1.03 to -0.17; P = .007) and during activity (MD, -1.05; 95% CI, -1.54 to -0.56; P < .0001) were significantly lower in QL block. Time to the first analgesic rescue (MD, 21.67; 95% CI, -18.58 to 61.91; P = .29) and opioid consumption (MD, -1.96; 95% CI, -4.59 to 0.66; P = .14) were similar in both groups. No difference was found in the incidence of postoperative nausea and vomiting and sedation. However, patients treated with QL block reported higher patient satisfaction scores. CONCLUSIONS There is limited evidence to suggest that QL block is superior to TAP block for postoperative pain management in nonemergent cesarean delivery. The study limitations must be considered when extrapolating the review's findings to clinical practice.
Collapse
Affiliation(s)
- Jeffery E Ferguson
- Graduate Programs of Nurse Anesthesia, Middle Tennessee School of Anesthesia, Madison, TN.
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - William Johnson
- Graduate Programs of Nurse Anesthesia, Middle Tennessee School of Anesthesia, Madison, TN
| | - Hallie Evans
- Graduate Programs of Nurse Anesthesia, Middle Tennessee School of Anesthesia, Madison, TN
| | - James Furstein
- Graduate Programs of Nurse Anesthesia, Middle Tennessee School of Anesthesia, Madison, TN
| |
Collapse
|
2
|
Wang F, Lü Q, Wang M, Xu H, Xie D, Yang Z, Ye Q. Ultrasound-guided caudal anaesthesia combined with epidural anaesthesia for caesarean section: a randomized controlled clinical trial. BMC Pregnancy Childbirth 2024; 24:105. [PMID: 38308257 PMCID: PMC10835986 DOI: 10.1186/s12884-024-06298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Although epidural anaesthesia and spinal anaesthesia are currently the general choices for patients undergoing caesarean section, these two neuraxial anaesthesia methods still have drawbacks. Caudal anaesthesia has been considered to be more appropriate for gynaecological surgery. The purpose of this study was to compare epidural anaesthesia combined with caudal anaesthesia, spinal anaesthesia and single-space epidural anaesthesia for caesarean section with respect to postoperative comfort and intraoperative anaesthesia quality. METHODS In this clinical trial, 150 patients undergoing elective caesarean section were recruited and randomized into three groups according to a ratio of 1:1:1to receive epidural anaesthesia only, spinal anaesthesia only or epidural anaesthesia combined with caudal anaesthesia. The primary outcome was postoperative comfort in the three groups. Secondary outcomes included intraoperative anaesthesia quality and the incidences of nausea, vomiting, postdural puncture headache, maternal bradycardia, or hypotension. RESULTS More patients were satisfied with the intraoperative anaesthesia quality in the EAC group than in the EA group (P = 0.001). The obstetrician was more significantly satisfied with the intraoperative anaesthesia quality in the SA and EAC groups than in the EA group (P = 0.004 and 0.020, respectively). The parturients felt more comfortable after surgery in the EA and EAC groups (P = 0.007). The incidence of maternal hypotension during caesarean section was higher in the SA group than in the EA and EAC groups (P = 0.001 and 0.019, respectively). CONCLUSIONS Epidural anaesthesia combined with caudal anaesthesia may be a better choice for elective caesarean section. Compared with epidural anaesthesia and spinal anaesthesia, it has a higher quality of postoperative comfort and intraoperative anaesthesia.
Collapse
Affiliation(s)
- Fangjun Wang
- Department of Anesthesiology, Affiliated Hospital, North Sichuan Medical College, No. 63, Cultural Road, Shunqing District, NanchongCity, Sichuan Province, China.
| | - Qi Lü
- Department of Operation Center, Affiliated Hospital, North Sichuan Medical College, Nanchong, 637000, China
| | - Min Wang
- North Sichuan Medical College, Nanchong, 637000, China
| | - Hongchun Xu
- Department of Anesthesiology, Affiliated Hospital, North Sichuan Medical College, No. 63, Cultural Road, Shunqing District, NanchongCity, Sichuan Province, China
| | - Dan Xie
- Department of Anesthesiology, Affiliated Hospital, North Sichuan Medical College, No. 63, Cultural Road, Shunqing District, NanchongCity, Sichuan Province, China
| | - Zheng Yang
- North Sichuan Medical College, Nanchong, 637000, China
| | - Qin Ye
- North Sichuan Medical College, Nanchong, 637000, China
| |
Collapse
|
3
|
Yue L, Zhang F, Mu G, Shang M, Lin Z, Sun H. Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial. Spine J 2023; 23:954-961. [PMID: 36931566 DOI: 10.1016/j.spinee.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND CONTEXT Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD. PURPOSE This study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine. STUDY DESIGN A double-blind, randomized, placebo-controlled trial. TRIAL REGISTRATION ChiCTR2000039842 (www.chictr.org.cn). SAMPLE Ninety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine. OUTCOME MEASURES The primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients' satisfaction with anesthesia; adverse events; and radiographic outcomes. METHODS Patients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM. RESULTS The overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09-64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient. CONCLUSION The addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.
Collapse
Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Feng Zhang
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Guanzhang Mu
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing,100034, China
| | - Zengmao Lin
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
| |
Collapse
|
4
|
Xu LL, Wang C, Deng CM, Dai SB, Zhou Q, Peng YB, Shou HY, Han YQ, Yu J, Liu CH, Xia F, Zhang SQ, Wang DX, Chen XZ. Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e239321. [PMID: 37083664 PMCID: PMC10122167 DOI: 10.1001/jamanetworkopen.2023.9321] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. Objective To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia. Design, Setting, and Participants This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022. Intervention Patients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. Main Outcomes and Measures The coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth. Results A total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P < .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P < .001). Conclusions and Relevance For women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia. Trial Registration ClinicalTrials.gov Identifier: NCT04548973.
Collapse
Affiliation(s)
- Li-Li Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chun Wang
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chun-Mei Deng
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shao-Bing Dai
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qun Zhou
- Department of Anesthesiology, Jiangxi Maternal and Child Health Hospital, Jiangxi Province, China
| | - Yong-Bao Peng
- Department of Anesthesiology, Jiangxi Maternal and Child Health Hospital, Jiangxi Province, China
| | - Hong-Yan Shou
- Department of Anesthesiology, Hangzhou Women's Hospital, Zhejiang, China
| | - Yin-Qiu Han
- Department of Anesthesiology, Hangzhou Women's Hospital, Zhejiang, China
| | - Jing Yu
- Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Chao-Hui Liu
- Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Feng Xia
- Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China
| | - Su-Qin Zhang
- Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xin-Zhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| |
Collapse
|
5
|
Mostic Stanisic D, Kalezic N, Rajovic N, Ilic Mostic T, Cumic J, Stanisavljevic T, Beleslin A, Stulic J, Rudic I, Divac N, Milic N, Stojanovic R. Effect of regional vs general anesthesia on vital functions after cesarean section: a single center experience. Hypertens Pregnancy 2022; 41:198-203. [DOI: 10.1080/10641955.2022.2124417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Danka Mostic Stanisic
- Clinic for Gynecology and Obstetrics, Clinical Center “Dragisa Misovic–Dedinje”, Belgrade, Serbia
- Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nevena Kalezic
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Tatjana Ilic Mostic
- Department of Anesthesiology, Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Cumic
- Department of Anesthesiology, Clinic for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Aleksandra Beleslin
- Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Stulic
- Clinic for Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
| | - Ivana Rudic
- Clinic for Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
| | - Nevena Divac
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Radan Stojanovic
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Belgrade, Serbia
| |
Collapse
|
6
|
Jee Y, Lee HJ, Kim YJ, Kim DY, Woo JH. Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data. Anesth Pain Med (Seoul) 2022; 17:165-172. [PMID: 35038857 PMCID: PMC9091673 DOI: 10.17085/apm.21068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is a major cause of maternal mortality and the risk factors for PPH differ among studies. In this large-scale study, we investigated whether the anesthetic method used was associated with PPH after cesarean section. Methods We extracted data on cesarean sections performed between January 2008 and June 2013 from the National Health Insurance Service database. The anesthetic methods were categorized into general, spinal and epidural anesthesia. To compare the likelihood of PPH among deliveries using different anesthetic methods, crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression analysis. Results Data from 330,324 cesarean sections were analyzed, and 21,636 cases of PPH were identified. Univariate analysis showed that general and epidural anesthesia increased the risk of PPH compared to spinal anesthesia. The OR for PPH was highest for morbidly adherent placenta, followed by placenta previa, placental abruption, and hypertension. When other clinical covariates were controlled for, general and epidural anesthesia still remained significant risk factors for PPH compared to spinal anesthesia. Conclusions This study showed that general and epidural anesthesia elevated the risk of PPH compared to spinal anesthesia during cesarean section. Since we could not consider the potential bias of group differences in indications, more in-depth clinical trials are needed to validate our findings. Obstetric factors such as placental abnormalities had high odds ratios and thus are more important than the choice of anesthetic method, which should be based on the patient's clinical condition and institutional resources.
Collapse
Affiliation(s)
- Yongho Jee
- Advanced Biomedical Research Institute, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Al-Husban N, Elmuhtaseb MS, Al-Husban H, Nabhan M, Abuhalaweh H, Alkhatib YM, Yousef M, Aloran B, Elyyan Y, Alghazo A. Anesthesia for Cesarean Section: Retrospective Comparative Study. Int J Womens Health 2021; 13:141-152. [PMID: 33564269 PMCID: PMC7866905 DOI: 10.2147/ijwh.s292434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background Cesarean section is a widely performed surgery. Objective To compare anesthetic types regarding feto-maternal outcomes. Materials and Methods Retrospective comparative study of 3599 cesarean sections (emergency and elective categories). Results Mean APGAR score was statistically higher in the spinal than general anesthesia among the emergency category, P = 0.000 and 0.026, respectively, with no significant difference in the elective category. Estimated blood loss among the elective category was statistically significantly higher in the spinal than general anesthesia, P = 0.001. However, among the emergency category, it was significantly higher in the general than in spinal or epidural anesthesia, P = 0.000. Diclofenac sodium was used more after spinal than general anesthesia (P = 0.000), with no significant difference between epidural and general or between epidural and spinal anesthesia. Pethidine hydrochloride (HCL) was used more after general than after spinal anesthesia (P = 0.000). However, pethidine HCL use was not statistically significantly different between spinal and epidural anesthesia. In the elective category, paracetamol was requested more after spinal than epidural or general anesthesia, P = 0.000. No significant difference was seen between epidural and general anesthesia, P = 1.000. No statistically significant difference was found among the anesthetic types in both categories regarding tramadol HCL. Length of hospital stay, operative time and neonatal intensive care unit admission were not statistically different between anesthetic modes. In the emergency category, significantly higher percentage of patients were satisfied with and would recommend epidural anesthesia. Conclusion There was no statistically significant difference among the three types of anesthesia regarding neonatal intensive care admission and length of hospital stay for emergency and elective categories. APGAR score was higher with spinal than with general anesthesia in the emergency category with no significant difference in the elective category. More diclofenac sodium and paracetamol and less opioids were used after regional than after general anesthesia. Satisfaction was higher with epidural anesthesia. Limitations Retrospective and single centered.
Collapse
Affiliation(s)
- Naser Al-Husban
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Mohammed Nabhan
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| | - Hamza Abuhalaweh
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| | | | - Maysa Yousef
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| | - Bayan Aloran
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| | - Yousef Elyyan
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| | - Asma Alghazo
- Obstetrics and Gynecology Department, Jordan University Hospital, Amman, Jordan
| |
Collapse
|
8
|
An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal-epidural anesthesia: a retrospective study. JA Clin Rep 2021; 7:3. [PMID: 33398592 PMCID: PMC7782655 DOI: 10.1186/s40981-020-00405-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background Epidural anesthesia affects lower extremities, which often prevents early mobilization postoperatively. The incidence of numbness and motor weakness in the lower extremities with respect to epidural catheter placement site in cesarean section (CS) is uncertain. We aimed to investigate the effect of catheter placement site on postoperative lower extremities numbness and motor weakness in patients who received combined spinal–epidural anesthesia (CSEA) for CS including analgesic effects and optimal epidural placement site in CS. Methods We retrospectively included 205 patients who underwent CS with CSEA at the University of Tsukuba Hospital between April 2018 and March 2020, and assessed numbness and motor weakness in the lower extremities. We also examined whether differences in the intervertebral space of epidural catheter placement and epidural effect on the lower extremities are related to analgesic effects. ANOVA and Mann–Whitney U test were used for statistical analysis. Results The incidence of numbness and motor weakness were 67 (33%) and 28 (14%), respectively. All patients with motor weakness had numbness. A more caudal placement was associated with increased incidence of affected lower extremities. There was no significant difference in the analgesic effect depending on the catheter placement site. When the lower extremities were affected, the number of additional analgesics increased (p < 0.001). Patient-controlled epidural analgesia was used for fewer days in patients with motor weakness (p = 0.046). Conclusion In CS, epidural catheter placement at T10–11 or T11–12 interspace is expected to reduce effect on the lower extremities and improve quality of postoperative analgesia.
Collapse
|
9
|
The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study. J Anesth 2020; 34:825-833. [PMID: 32627064 DOI: 10.1007/s00540-020-02820-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section. METHODS A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48 h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed. RESULTS Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6 h and 12 h after surgery. VAS scores for uterine cramping pain during movement at 6 h, 12 h, and 24 h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05). CONCLUSION PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section. CLINICAL TRIAL REGISTRATION The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.
Collapse
|
10
|
Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, Li H. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol 2019; 19:189. [PMID: 31640565 PMCID: PMC6806491 DOI: 10.1186/s12871-019-0865-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 09/30/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas. METHODS A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone. RESULTS From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011). CONCLUSION Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. TRAIL REGISTRATION ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.
Collapse
Affiliation(s)
| | | | - Jing Peng
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Zhenxin Duan
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Xianglong Tang
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
| |
Collapse
|
11
|
Grace RF. Post-Caesarean analgesia in Timor-Leste, a low-middle-income country. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2019. [DOI: 10.36303/sajaa.2019.25.4.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Timor-Leste is a small, low-middle-income country in Southeast Asia. It is reported to spend less on healthcare than any other country. Hospital Nacional Guido Valadares performs 6 000 deliveries a year. Epidural analgesia, intrathecal opiates, transversus abdominis plane blocks, oral and intravenous opiates, and non-steroidal anti-inflammatory agents have all been mooted as techniques useful in improving post-caesarean analgesia. Most of these options are unavailable in Timor-Leste. Opiate use in theatre is minimal and opiates are unavailable on the ward. Epidural anaesthesia and patient controlled analgesia are unavailable. A locally formulated post-caesarean pain management protocol, taking into account available agents and expertise, encourages spinal anaesthesia with hyperbaric bupivacaine followed by 100 mg intramuscular tramadol in the recovery area, followed by oral paracetamol 1 gm qid., tramadol 50 mg qid. and ibuprofen 400 mg tds. in the wards. This study sought to determine the efficacy of this protocol in a low resource environment.
Collapse
Affiliation(s)
- RF Grace
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| |
Collapse
|
12
|
Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L, Nelson G, Wilson RD. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol 2018; 219:533-544. [PMID: 30118692 DOI: 10.1016/j.ajog.2018.08.006] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
Abstract
The Enhanced Recovery After Surgery Society guideline for intraoperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for intraoperative care, with primarily a maternal focus. The "focused" pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider procedure from the decision to operate (starting with the 30-60 minutes before skin incision) through the surgery. The literature search (1966-2017) used Embase and PubMed to search medical subject headings including "cesarean section," "cesarean section," "cesarean section delivery," and all pre- and intraoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Society guidelines. The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30-60 minutes before skin incision to maternal discharge) with Enhanced Recovery After Surgery-directed preoperative elements, intraoperative elements, and postoperative elements. Specifics of the intraoperative care included the use of prophylactic antibiotics before the cesarean delivery, appropriate patient warming intraoperatively, blunt expansion of the transverse uterine hysterotomy, skin closure with subcuticular sutures, and delayed cord clamping. A number of specific elements of intraoperative care of women who undergo cesarean delivery are recommended based on the evidence. The Enhanced Recovery After Surgery Society guideline for intraoperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for intraoperative care with primarily a maternal focus. When the cesarean delivery pathway (elements/processes) is studied, implemented, audited, evaluated, and optimized by maternity care teams, this will create an opportunity for the focused and optimized areas of care and recommendations to be further enhanced.
Collapse
|
13
|
Kiasari AZ, Babaei A, Alipour A, Motevalli S, Baradari AG. Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial. Med Arch 2017; 71:274-279. [PMID: 28974849 PMCID: PMC5585788 DOI: 10.5455/medarh.2017.71.274-279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries. MATERIALS AND METHODS In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery. RESULTS SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively). CONCLUSION Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.
Collapse
Affiliation(s)
- Alieh Zamani Kiasari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Anahita Babaei
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shima Motevalli
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Afshin Gholipour Baradari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
14
|
[Recent standards in management of obstetric anesthesia]. Wien Med Wochenschr 2017; 167:374-389. [PMID: 28744777 DOI: 10.1007/s10354-017-0584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
The following article contains information not only for the clinical working anaesthesiologist, but also for other specialists involved in obstetric affairs. Besides a synopsis of a German translation of the current "Practice Guidelines for Obstetric Anaesthesia 2016" [1], written by the American Society of Anesthesiologists, the authors provide personal information regarding major topics of obstetric anaesthesia including pre-anaesthesia patient evaluation, equipment and staff at the delivery room, use of general anaesthesia, peridural analgesia, spinal anaesthesia, combined spinal-epidural anaesthesia, single shot spinal anaesthesia, and programmed intermittent epidural bolus.
Collapse
|
15
|
Abstract
Abstract
The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology present an updated report of the Practice Guidelines for Obstetric Anesthesia.
Supplemental Digital Content is available in the text.
Collapse
|
16
|
Suzuki H, Kamiya Y, Fujiwara T, Yoshida T, Takamatsu M, Sato K. Intrathecal morphine versus epidural ropivacaine infusion for analgesia after Cesarean section: a retrospective study. JA Clin Rep 2015; 1:3. [PMID: 29497635 PMCID: PMC5818688 DOI: 10.1186/s40981-015-0005-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Analgesia after Cesarean delivery (CD) requires early ambulation to prevent thromboembolic disease and to facilitate baby care. We retrospectively reviewed anesthesia charts and medical records of patients who underwent CD to compare the efficacy of spinal anesthesia supplemented with intrathecal morphine hydrochloride (ITM) and combined spinal–epidural anesthesia followed by opioid-free epidural analgesia (CSEA-EDA). Findings All subjects underwent CD at Nagaoka Chuo General Hospital between February 2012 and January 2013. Patient characteristics, time to first analgesic rescue after CD, and analgesic use after CD were examined. Incidences of postural hypotension, lower extremity numbness/weakness, postoperative nausea/vomiting (PONV), and pruritus were also examined for 48 h after CD. Average time to first analgesic use after CD (ITM 25.13 ± 16.07 h, CSEA-EDA 22.42 ± 16.27 h, p = 0.521) and cumulative probability of rescue analgesic use (p = 0.139 by log-rank test) were comparable between groups. However, average analgesic use within 24 h was lower in the ITM group (0.75 ± 1.05 times) than in the CSEA-EDA group (1.52 ± 1.72 times, p = 0.0497). Numbness or motor weakness in lower extremities only occurred in the CSEA-EDA group, and pruritus only occurred in the ITM group. Conclusions The results of this study suggest that ITM is better than CSEA-EDA for anesthesia following CD with regard to pain control. Also, ITM would be advantageous for early ambulation following CD because of lower incidence of numbness and motor weakness in lower extremities compared to CSEA-EDA.
Collapse
Affiliation(s)
- Hiroko Suzuki
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan.,Department of Anesthesia, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata 940-8653 Japan
| | - Yoshinori Kamiya
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan.,Present address: Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-uonuma, Niigata 949-7302 Japan
| | - Takashi Fujiwara
- Department of Anesthesia, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata 940-8653 Japan
| | - Takayuki Yoshida
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan
| | - Misako Takamatsu
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan
| | - Kazunori Sato
- Department of Anesthesia, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata 940-8653 Japan
| |
Collapse
|
17
|
Soto Mesa D, Trespalacios Guerra R, Albaladejo Magdalena J, Fayad Fayad M. [Influence of the type of anesthesia and the level of urgency in post-surgical pain after a cesarian]. ACTA ACUST UNITED AC 2015; 62:350-1. [PMID: 25600620 DOI: 10.1016/j.redar.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- D Soto Mesa
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, Asturias, España.
| | - R Trespalacios Guerra
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, Asturias, España
| | | | - M Fayad Fayad
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, Asturias, España
| |
Collapse
|
18
|
Marcus H, Gerbershagen H, Peelen L, Aduckathil S, Kappen T, Kalkman C, Meissner W, Stamer U. Quality of pain treatment after caesarean section: Results of a multicentre cohort study. Eur J Pain 2014; 19:929-39. [DOI: 10.1002/ejp.619] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/08/2022]
Affiliation(s)
- H. Marcus
- Department of Anaesthesiology and Intensive Care Medicine; University of Cologne; Germany
| | - H.J. Gerbershagen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - L.M. Peelen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; The Netherlands
| | - S. Aduckathil
- Department of Anaesthesiology and Intensive Care Medicine; University of Cologne; Germany
| | - T.H. Kappen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - C.J. Kalkman
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - W. Meissner
- Department of Anaesthesiology and Intensive Care Medicine; Jena University Hospital; Germany
| | - U.M. Stamer
- Department of Anaesthesiology and Intensive Care Medicine; University of Bern; Switzerland
- Department of Anaesthesiology and Pain Medicine; Inselspital, University of Bern; Switzerland
- Department of Clinical Research; University of Bern; Switzerland
| |
Collapse
|
19
|
Nardi N, Campillo-Gimenez B, Pong S, Branchu P, Ecoffey C, Wodey E. Douleurs chroniques après césarienne : impact et facteurs de risque associés. ACTA ACUST UNITED AC 2013; 32:772-8. [DOI: 10.1016/j.annfar.2013.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
|
20
|
Rueda Fuentes JV, Pinzón Flórez CE, Vasco Ramírez M. Manejo anestésico para operación cesárea urgente: revisión sistemática de la literatura de técnicas anestésicas para cesárea urgente. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.rca.2012.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Anaesthetic management in emergency cesarean section: Systematic literature review of anaesthetic techniques for emergency C-section. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rcae.2012.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
22
|
Paraskeva A, Diamantis M, Petropoulos G, Siafaka I, Fassoulaki A. Postoperative analgesic requirements after subarachnoid or epidural anesthesia with ropivacaine 0.75% in cesarean section. A double-blind randomized trial. Curr Med Res Opin 2012; 28:1497-504. [PMID: 22937725 DOI: 10.1185/03007995.2012.722990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Postoperative analgesic requirements and pain scores were compared after subarachnoid versus epidural anesthesia with plain ropivacaine 0.75% for elective cesarean section. STUDY DESIGN Ropivacaine 0.75% was randomly administered for subarachnoid or epidural anesthesia in 108 parturients, scheduled for cesarean section. Times for the sensory block to reach T4 level and to regress to T6 level were recorded. At 2, 4, 8 and 24 h postoperatively, pain scores at rest and cough, morphine consumption as well as patient satisfaction, incidence of headache, nausea and/or vomiting were measured. RESULTS Median (min-max) time for the sensory block to reach T4 was 7 (3-0) min versus 24 (16-73) min and to regress to T6 was 126 (70-332) min versus 200 (98-439) min in the subarachnoid and epidural groups, respectively (p=0.001). Although the subarachnoid had more analgesic consumption than the epidural group at 2 and 4 h postoperatively (7.3±4.7 vs. 1.8±2.4 mg, p=0.001 and 9±5.7 vs. 3.3±3.8 mg, p=0.001, respectively) no difference was observed at 8 or 24 h postoperatively (p=0.14 and p=0.38, respectively). VAS scores at rest and after cough (p=0.56, p=0.35, respectively), patient satisfaction (p=0.61), incidence of headache (p=1.0), nausea and/or vomiting (p=0.78) did not differ between the two groups. CONCLUSIONS Postoperative pain, analgesic requirements, patient satisfaction and adverse effects did not differ when subarachnoid or epidural anesthesia with ropivacaine 0.75% was used for elective cesarean section. Nevertheless, subarachnoid provides faster onset and offset of the block, compared to epidural anesthesia. The key limitation of this study is the lack of postoperative serum ropivacaine measurements taken with concurrent pain score measurements.
Collapse
|
23
|
|
24
|
Anaesthetic management in emergency cesarean section: Systematic literature review of anaesthetic techniques for emergency C-section☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240040-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
25
|
Lavand’homme P. Chronic pain after vaginal and cesarean delivery: a reality questioning our daily practice of obstetric anesthesia. Int J Obstet Anesth 2010; 19:1-2. [DOI: 10.1016/j.ijoa.2009.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/23/2009] [Indexed: 11/28/2022]
|